{"hospital_name":"Gothenburg Health","standard_charge_information":[{"description":"Cabazitaxel 60mg/1.5ml [Gmh]","code_information":[{"code":"CP17805909631404387","type":"CDM"},{"code":"250","type":"RC"},{"code":"00024582411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21183,"maximum":33131,"gross_charge":34511,"discounted_cash":31060,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21742},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21397},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32785},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32095},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21183},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21397}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Brentuximab Vedotin 50 Mg Pow [Gmh]","code_information":[{"code":"4507205","type":"CDM"},{"code":"250","type":"RC"},{"code":"51144005001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18003,"maximum":28157,"gross_charge":29330,"discounted_cash":26397,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18478},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27864},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27277},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18003},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18185}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Luspatercept Aamt 75 Mg Pow [Gmh]","code_information":[{"code":"4507085","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572077501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17852,"maximum":27921,"gross_charge":29084,"discounted_cash":26176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18323},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27921},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18032},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27630},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27048},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17852},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18032}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Atezolizumab 1200 Mg/20 Ml Sol [Gmh]","code_information":[{"code":"4507047","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242091701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16606,"maximum":25972,"gross_charge":27054,"discounted_cash":24349,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17044},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25972},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16773},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25701},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25160},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16606},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16773}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Pegfilgrastim On-body 6 Mg/0.6 Ml Sol [Gmh]","code_information":[{"code":"4506039","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15770,"maximum":24664,"gross_charge":25692,"discounted_cash":23123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24664},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15929},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24407},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23894},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15770},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15929}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Daratumumab-hyaluronidase Fihj 1800 Mg-30,000 Units/15 Ml Sol [Gmh]","code_information":[{"code":"4507166","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894050301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14795,"maximum":23140,"gross_charge":24104,"discounted_cash":21694,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14944},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22899},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22417},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14795},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14944}]}],"drug_information":{"unit":1800,"type":"ME"}},{"description":"64590 Implant Of Neurolog Devic","code_information":[{"code":"3305200","type":"CDM"},{"code":"360","type":"RC"},{"code":"64590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14577,"maximum":22798,"gross_charge":23748,"discounted_cash":21373,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14961},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22798},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14724},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22561},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22086},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14577}]}]},{"description":"Vedolizumab 300 Mg Pow [Gmh]","code_information":[{"code":"4507068","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764030020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13819,"maximum":21613,"gross_charge":22514,"discounted_cash":20263,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14184},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21613},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13959},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21388},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20938},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13819},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13959}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Tenecteplase 50 Mg Pow","code_information":[{"code":"4507002","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242017601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12235,"maximum":19136,"gross_charge":19933,"discounted_cash":17940,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12558},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12358},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18936},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18538},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12235},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12358}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nivolumab 240 Mg/ 24 Ml Sol [Gmh]","code_information":[{"code":"4507121","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003373413","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11503,"maximum":17990,"gross_charge":18740,"discounted_cash":16866,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11806},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17990},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11619},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17803},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17428},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11503},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11619}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Lurbinectedin 4 Mg Pow","code_information":[{"code":"4507127","type":"CDM"},{"code":"250","type":"RC"},{"code":"68727071201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11285,"maximum":17651,"gross_charge":18386,"discounted_cash":16547,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11583},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17651},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11399},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17467},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17099},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11285},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11399}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Interstim X Neurostimulator (C)","code_information":[{"code":"4301933","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301933","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11248,"maximum":17592,"gross_charge":18325,"discounted_cash":16493,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11545},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17592},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11362},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17409},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17042},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11248}]}]},{"description":"Immune Globulin Intravenous 10% Sol [Gmh]","code_information":[{"code":"4505027","type":"CDM"},{"code":"250","type":"RC"},{"code":"44206043940","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11107,"maximum":17371,"gross_charge":18095,"discounted_cash":16286,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11400},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17371},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11219},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16828},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11107},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11219}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Eflapegrastim Xnst 13.2 Mg/0.6 Ml Sol [Gmh]","code_information":[{"code":"4507204","type":"CDM"},{"code":"250","type":"RC"},{"code":"76961010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11061,"maximum":17299,"gross_charge":18020,"discounted_cash":16218,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11353},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17299},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11172},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17119},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16759},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11061},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11172}]}],"drug_information":{"unit":132,"type":"ME"}},{"description":"53850 Microwave Thermo Therapy","code_information":[{"code":"3302000","type":"CDM"},{"code":"360","type":"RC"},{"code":"53850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10713,"maximum":16756,"gross_charge":17454,"discounted_cash":15709,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10996},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16756},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10821},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16581},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16232},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10713}]}]},{"description":"Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sol [Gmh]","code_information":[{"code":"4507203","type":"CDM"},{"code":"250","type":"RC"},{"code":"69448002763","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10263,"maximum":16051,"gross_charge":16720,"discounted_cash":15048,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10534},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16051},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10366},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15884},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15550},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10263},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10366}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Pertuzumab 420 Mg/14 Ml Sol [Gmh]","code_information":[{"code":"4506024","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242014501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10078,"maximum":15762,"gross_charge":16419,"discounted_cash":14777,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10344},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15762},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15598},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15270},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10078},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10180}]}],"drug_information":{"unit":420,"type":"ME"}},{"description":"Leuprolide 22.5 Mg/3 Months Pwd","code_information":[{"code":"4506026","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074334603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9497,"maximum":14854,"gross_charge":15473,"discounted_cash":13926,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9748},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14854},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9593},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14699},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14390},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9497},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9593}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Pegfilgrastim 6. Mg Soln [Gmh]","code_information":[{"code":"4503752","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9467,"maximum":14806,"gross_charge":15423,"discounted_cash":13881,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9716},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14806},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9562},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14652},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14343},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9467},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9562}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Certolizumab Kit [Gmh]","code_information":[{"code":"4501075","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474071079","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8850,"maximum":13842,"gross_charge":14419,"discounted_cash":12977,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9084},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13842},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8940},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13698},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13410},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8850},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8940}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pembrolizumab 25 Mg/ml Sol [Gmh]","code_information":[{"code":"4505097","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006302602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8548,"maximum":13370,"gross_charge":13927,"discounted_cash":12534,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8774},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13370},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8635},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13231},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12952},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8548},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8635}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Leuprolide 11.25 Mg/3 Months Pwd [Gmh]","code_information":[{"code":"4507035","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074366303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7972,"maximum":12468,"gross_charge":12988,"discounted_cash":11689,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12468},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8053},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12339},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12079},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7972},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8053}]}],"drug_information":{"unit":1125,"type":"ME"}},{"description":"Immune Globulin Intravenous And Subcutaneous 10% Sol [Gmh]","code_information":[{"code":"4505070","type":"CDM"},{"code":"250","type":"RC"},{"code":"00944270007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7729,"maximum":12088,"gross_charge":12592,"discounted_cash":11333,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7933},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12088},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7807},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11962},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11711},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7729},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7807}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Rituximab 500 Mg/50 Ml Iv Sol [Gmh]","code_information":[{"code":"4502013","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6951,"maximum":10871,"gross_charge":11324,"discounted_cash":10192,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10871},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7021},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10758},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10531},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6951},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7021}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Rituximab Abbs 10 Mg/ml 500mg Sol [Gmh]","code_information":[{"code":"4507086","type":"CDM"},{"code":"250","type":"RC"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6259,"maximum":9789,"gross_charge":10197,"discounted_cash":9177,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6424},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9789},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6322},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9687},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9483},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6259},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6322}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pegfilgrastim Jmdb 6 Mg/0.6 Ml Sol [Gmh]","code_information":[{"code":"4507088","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457083306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6163,"maximum":9638,"gross_charge":10040,"discounted_cash":9036,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6325},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9638},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6225},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9538},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9337},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6163},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6225}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Assert Iq Cardiac Monitor","code_information":[{"code":"4309625","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309625","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6077,"maximum":9504,"gross_charge":9900,"discounted_cash":8910,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6237},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9504},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9405},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9207},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6077}]}]},{"description":"Pemetrexed 500 Mg Pow [Gmh]","code_information":[{"code":"4505017","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002762301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5986,"maximum":9363,"gross_charge":9753,"discounted_cash":8778,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9363},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6047},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9265},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9070},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5986},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6047}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Durvalumab 50 Mg/ml Sol [Gmh]","code_information":[{"code":"4507169","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310461150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5945,"maximum":9298,"gross_charge":9685,"discounted_cash":8717,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6102},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6005},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9201},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9007},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5945},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6005}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nivolumab 120 Mg/ 12 Ml Sol [Gmh]","code_information":[{"code":"4507206","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003375614","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5881,"maximum":9199,"gross_charge":9582,"discounted_cash":8624,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6037},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9199},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5941},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9103},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8911},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5881},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5941}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Darbepoetin Alfa 500 Mcg/ml Sol [Gmh]","code_information":[{"code":"4506012","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5713,"maximum":8936,"gross_charge":9308,"discounted_cash":8377,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5864},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8936},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5771},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8843},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8656},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5713},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5771}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Immune Globulin Intravenous 10% Sol [Gmh]","code_information":[{"code":"4505033","type":"CDM"},{"code":"250","type":"RC"},{"code":"44206043820","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5559,"maximum":8695,"gross_charge":9057,"discounted_cash":8151,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5706},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8695},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5615},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8604},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8423},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5559},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5615}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Jot Dx Dm4500","code_information":[{"code":"4309583","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309583","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5386,"maximum":8424,"gross_charge":8775,"discounted_cash":7898,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5528},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8424},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5441},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8336},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8161},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5386}]}]},{"description":"Denosumab 120 Mg/1.7 Ml Sol [Gmh]","code_information":[{"code":"4501042","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513073021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5094,"maximum":7967,"gross_charge":8299,"discounted_cash":7469,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5228},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7967},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5145},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7884},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7718},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5094},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5145}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Inclisiran 284 Mg/1.5 Ml Sol {Gmh]","code_information":[{"code":"4507164","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078100060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4982,"maximum":7791,"gross_charge":8116,"discounted_cash":7304,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7791},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5032},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7710},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7548},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4982},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5032}]}],"drug_information":{"unit":284,"type":"ME"}},{"description":"Rabies Immune Globulin, Human 300 Units/ml 5 Ml Sol [Gmh]","code_information":[{"code":"4506064","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533031805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4950,"maximum":7742,"gross_charge":8065,"discounted_cash":7259,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5081},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7742},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5000},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7662},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7500},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4950},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5000}]}],"drug_information":{"unit":300,"type":"UN"}},{"description":"Removal of gallbladder using an endoscope","code_information":[{"code":"CP17805909763611828","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"47562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4928,"maximum":7708,"gross_charge":8029,"discounted_cash":7226,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5058},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7708},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4978},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7628},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7467},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4928}]}]},{"description":"Polyvalent Immune Fab, Anti Snake [Gmh]","code_information":[{"code":"4503842","type":"CDM"},{"code":"250","type":"RC"},{"code":"50633011012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4723,"maximum":7387,"gross_charge":7695,"discounted_cash":6926,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4848},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7387},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4771},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7310},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7156},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4723},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4771}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Obstetric care, planned vaginal delivery","code_information":[{"code":"CP17805909763616130","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"59400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4665,"maximum":7296,"gross_charge":7600,"discounted_cash":6840,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4788},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4712},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7220},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7068},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4665}]}]},{"description":"Acetic Acid 5% Solution 50 Ml [Gmh]","code_information":[{"code":"4507210","type":"CDM"},{"code":"250","type":"RC"},{"code":"51552005503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4308,"maximum":6737,"gross_charge":7018,"discounted_cash":6316,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4421},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6737},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4351},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6667},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6527},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4308},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4351}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ct Angio Head/neck W/ Contrast","code_information":[{"code":"3760083-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70471","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":4266,"maximum":6672,"gross_charge":6950,"discounted_cash":6255,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4379},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4309},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6603},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6464},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4266}]}]},{"description":"64581 Incision Implnt Neuro Ele","code_information":[{"code":"3305000","type":"CDM"},{"code":"360","type":"RC"},{"code":"64581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4186,"maximum":6546,"gross_charge":6819,"discounted_cash":6137,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4296},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6546},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4228},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6478},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6342},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4186}]}]},{"description":"Lead Kit Is2 28cm (C)","code_information":[{"code":"4301924","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301924","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4152,"maximum":6494,"gross_charge":6765,"discounted_cash":6089,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4262},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6494},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4194},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6427},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6291},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4152}]}]},{"description":"Bevacizumab Awwb 25 Mg/ml Sol [Gmh]","code_information":[{"code":"4507069","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4142,"maximum":6478,"gross_charge":6748,"discounted_cash":6073,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6478},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4184},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6411},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6276},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4142},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4184}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Omalizumab 300 Mg/2 Ml Sol [Gmh]","code_information":[{"code":"4507163","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242022755","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4093,"maximum":6401,"gross_charge":6668,"discounted_cash":6001,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4201},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6401},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6335},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6201},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4093},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4134}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Leuprolide 45 Mg/6 Months Pwd [Gmh]","code_information":[{"code":"4507114","type":"CDM"},{"code":"250","type":"RC"},{"code":"62935046150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4004,"maximum":6263,"gross_charge":6524,"discounted_cash":5872,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6263},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4045},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6198},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6067},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4004},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4045}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Ct Whole Body Low Dose","code_information":[{"code":"3760079","type":"CDM"},{"code":"350","type":"RC"},{"code":"76497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3990,"maximum":6240,"gross_charge":6500,"discounted_cash":5850,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4095},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4030},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6175},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6045},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3990}]}]},{"description":"Ct Angio Abdomen Pelvis","code_information":[{"code":"3760103-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74174","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3928,"maximum":6144,"gross_charge":6400,"discounted_cash":5760,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4032},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3968},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6080},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5952},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3928}]}]},{"description":"Tocilizumab 20 Mg/ml Sol","code_information":[{"code":"4507193","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3925,"maximum":6138,"gross_charge":6394,"discounted_cash":5755,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4028},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3964},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6074},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5946},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3925},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3964}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Trastuzumab Dkst 420 Mg Pow [Gmh]","code_information":[{"code":"4507219","type":"CDM"},{"code":"250","type":"RC"},{"code":"83257000412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3898,"maximum":6096,"gross_charge":6350,"discounted_cash":5715,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4001},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6096},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3937},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6033},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5906},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3898},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3937}]}],"drug_information":{"unit":420,"type":"ME"}},{"description":"Ct Abdomen +Pelvis W/ + W/o Cont","code_information":[{"code":"3760066-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74178","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3775,"maximum":5904,"gross_charge":6150,"discounted_cash":5535,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3875},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5904},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3813},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5843},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5720},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3775}]}]},{"description":"Romosozumab 210 Mg/2.34 Ml Sol [Gmh]","code_information":[{"code":"4507165","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3701,"maximum":5788,"gross_charge":6029,"discounted_cash":5426,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3798},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5788},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3738},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5728},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5607},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3701},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3738}]}],"drug_information":{"unit":210,"type":"ME"}},{"description":"Bendamustine 25 Mg/ml 4ml Sol [Gmh]","code_information":[{"code":"4507143","type":"CDM"},{"code":"250","type":"RC"},{"code":"63459034804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3675,"maximum":5748,"gross_charge":5987,"discounted_cash":5388,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3772},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5748},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3712},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5688},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5568},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3675},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3712}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"58291 Vaginal Hysterectomy, For Uterus Greater Than 250g With Removal Of Tube(s) And/or Ovary(s)","code_information":[{"code":"3337101","type":"CDM"},{"code":"58291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3550,"maximum":5553,"gross_charge":5784,"discounted_cash":5206,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3644},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5553},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3586},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5495},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5379},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3550}]}]},{"description":"Mri Spine Thoracic W/ + W/o Cont","code_information":[{"code":"3770045-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3500,"maximum":5474,"gross_charge":5702,"discounted_cash":5132,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3592},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5474},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3535},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5417},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5303},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3500}]}]},{"description":"Mri Spine Cervical W/ + W/o Cont","code_information":[{"code":"3770040-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3384,"maximum":5293,"gross_charge":5514,"discounted_cash":4963,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3474},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5293},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5128},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3384}]}]},{"description":"58280 Vaginal Hysterectomy, With Total Or Partial Vaginectomy With Repair Of Enterocele","code_information":[{"code":"3337098","type":"CDM"},{"code":"58280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3383,"maximum":5292,"gross_charge":5512,"discounted_cash":4961,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5292},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3417},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5236},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3383}]}]},{"description":"58290 Vaginal Hysterectomy, For Uterus Greater Than 250g","code_information":[{"code":"3337100","type":"CDM"},{"code":"58290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3272,"maximum":5118,"gross_charge":5331,"discounted_cash":4798,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3359},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3305},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5064},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4958},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3272}]}]},{"description":"Obstetric care, planned cesarean delivery","code_information":[{"code":"CP17805909763612870","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"59510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3255,"maximum":5091,"gross_charge":5303,"discounted_cash":4773,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3341},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5091},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5038},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4932},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3255}]}]},{"description":"CT scan of abdomen and pelvis with contrast","code_information":[{"code":"3760101-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74177","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3253,"maximum":5088,"gross_charge":5300,"discounted_cash":4770,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3339},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5088},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3286},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5035},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4929},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3253}]}]},{"description":"Biopsy exam of large bowel using an endoscope","code_information":[{"code":"CP17805909763615010","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3214,"maximum":5027,"gross_charge":5236,"discounted_cash":4712,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5027},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4974},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4869},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3214}]}]},{"description":"95811 Sleep Study W Cpap","code_information":[{"code":"4100024-TC","type":"CDM"},{"code":"920","type":"RC"},{"code":"95811","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3192,"maximum":4992,"gross_charge":5200,"discounted_cash":4680,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3276},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4992},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4940},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4836},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3192}]}]},{"description":"Sleep Study Therapeutic C-pap Titration","code_information":[{"code":"4100015-TC","type":"CDM"},{"code":"920","type":"RC"},{"code":"95811","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3192,"maximum":4992,"gross_charge":5200,"discounted_cash":4680,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3276},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4992},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4940},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4836},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3192}]}]},{"description":"Sleep Study Split W/ C-pap Titration < 6 Hours Cp","code_information":[{"code":"4100023-TC","type":"CDM"},{"code":"920","type":"RC"},{"code":"95811","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3192,"maximum":4992,"gross_charge":5200,"discounted_cash":4680,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3276},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4992},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4940},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4836},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3192}]}]},{"description":"Shaving of shoulder bone using endoscope","code_information":[{"code":"CP17805909763614315","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3158,"maximum":4939,"gross_charge":5145,"discounted_cash":4631,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4939},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4888},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4785},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3158}]}]},{"description":"Secukinumab 25 Mg/ml  5ml Sol [Gmh]","code_information":[{"code":"4507162","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078116861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3128,"maximum":4892,"gross_charge":5096,"discounted_cash":4586,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3210},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4892},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4841},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4739},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3128},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3160}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Removal of tonsils and adenoid glands, patient younger than age 12","code_information":[{"code":"CP17805909763614687","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"42820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3090,"maximum":4834,"gross_charge":5035,"discounted_cash":4532,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3172},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4834},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4783},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4683},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3090}]}]},{"description":"Amnion Matrix 4x8","code_information":[{"code":"4301167","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301167","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3087,"maximum":4829,"gross_charge":5030,"discounted_cash":4527,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3169},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4829},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4779},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4678},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3087}]}]},{"description":"Mra Head W/o Cont","code_information":[{"code":"3770082-TC","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3077,"maximum":4812,"gross_charge":5013,"discounted_cash":4512,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4812},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4762},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4662},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3077}]}]},{"description":"Mri Spine Lumbar W/ Cont","code_information":[{"code":"3770035-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":3069,"maximum":4800,"gross_charge":5000,"discounted_cash":4500,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3150},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4800},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4750},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4650},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3069}]}]},{"description":"Golimumab 50 Mg/4 Ml Sol [Gmh]","code_information":[{"code":"4507140","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2957,"maximum":4625,"gross_charge":4818,"discounted_cash":4336,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3035},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4625},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2987},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4577},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4481},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2957},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2987}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"58270 Vaginal Hysterectomy, For Uterus 250g Or Less With Repair Of Enterocele","code_information":[{"code":"3337096","type":"CDM"},{"code":"58270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2935,"maximum":4591,"gross_charge":4782,"discounted_cash":4304,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3013},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4591},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2965},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4543},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4447},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2935}]}]},{"description":"58770 Salpingostomy (Salpingoneostomy)","code_information":[{"code":"3337134","type":"CDM"},{"code":"58770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2897,"maximum":4530,"gross_charge":4719,"discounted_cash":4247,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2973},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4530},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2926},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4483},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4389},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2897}]}]},{"description":"Mri Abdomen W/ + W/o Cont","code_information":[{"code":"3770073-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"74183","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2885,"maximum":4512,"gross_charge":4700,"discounted_cash":4230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2961},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4512},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2914},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4465},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4371},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2885}]}]},{"description":"Immune Globulin Intravenous And Subcutaneous 10% 20 Gm Sol Gamunex-c [Gmh]","code_information":[{"code":"4507076","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533080024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2860,"maximum":4474,"gross_charge":4660,"discounted_cash":4194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2936},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4474},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2889},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4427},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4334},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2860},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2889}]}],"drug_information":{"unit":20,"type":"GR"}},{"description":"Ct Abdomen +Pelvis W/o Cont","code_information":[{"code":"3760065-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74176","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2839,"maximum":4440,"gross_charge":4625,"discounted_cash":4163,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2914},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2868},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4394},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4301},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2839}]}]},{"description":"Mri Spine Lumbar W/ + W/o Cont","code_information":[{"code":"3770050-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2823,"maximum":4416,"gross_charge":4600,"discounted_cash":4140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2898},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4416},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2852},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4370},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4278},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2823}]}]},{"description":"Sleep study","code_information":[{"code":"4100010-TC","type":"CDM"},{"code":"920","type":"RC"},{"code":"95810","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2823,"maximum":4416,"gross_charge":4600,"discounted_cash":4140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2898},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4416},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2852},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4370},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4278},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2823}]}]},{"description":"Sleep study","code_information":[{"code":"4100022-TC","type":"CDM"},{"code":"920","type":"RC"},{"code":"95810","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2823,"maximum":4416,"gross_charge":4600,"discounted_cash":4140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2898},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4416},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2852},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4370},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4278},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2823}]}]},{"description":"Diagnostic exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"CP17805909763616334","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2787,"maximum":4359,"gross_charge":4541,"discounted_cash":4087,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2861},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4359},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2815},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4314},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2787}]}]},{"description":"Immune Globulin Intravenous 10% 10 Gm Sol [Gmh]","code_information":[{"code":"4505063","type":"CDM"},{"code":"250","type":"RC"},{"code":"44206043710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2786,"maximum":4357,"gross_charge":4539,"discounted_cash":4085,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2860},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4357},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2814},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4312},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4221},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2786},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2814}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"MRI Scan","code_information":[{"code":"3770015-TC","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2762,"maximum":4320,"gross_charge":4500,"discounted_cash":4050,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2835},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4320},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4275},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4185},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2762}]}]},{"description":"Mri Pelvis W/ + W/o Cont","code_information":[{"code":"3770056-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"72197","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2762,"maximum":4320,"gross_charge":4500,"discounted_cash":4050,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2835},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4320},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4275},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4185},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2762}]}]},{"description":"Nm Heart Image (3d) Multiple Study Tomographic Spect Multi Study At Rest Of Stress","code_information":[{"code":"4060001","type":"CDM"},{"code":"341","type":"RC"},{"code":"78452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2731,"maximum":4272,"gross_charge":4450,"discounted_cash":4005,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2804},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2759},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4228},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4139},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2731}]}]},{"description":"Removal of polyps or growths of large bowel using an endoscope","code_information":[{"code":"CP17805909763613892","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2723,"maximum":4260,"gross_charge":4437,"discounted_cash":3993,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2795},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2751},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4215},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2723}]}]},{"description":"Denosumab 60 Mg/ml Sol 1 Ml [Gmh]","code_information":[{"code":"4501085","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2644,"maximum":4135,"gross_charge":4307,"discounted_cash":3876,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2713},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2670},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4092},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4006},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2644},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2670}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Mra Neck W/ + W/o Cont","code_information":[{"code":"3770083-TC","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2639,"maximum":4128,"gross_charge":4300,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2709},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4128},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2666},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4085},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3999},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2639}]}]},{"description":"Mri Soft Tissue Neck W/ + W/o Cont","code_information":[{"code":"3770024-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"70543","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2639,"maximum":4128,"gross_charge":4300,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2709},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4128},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2666},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4085},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3999},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2639}]}]},{"description":"57545 Excision Of Cervical Stump; Abdominal Approach With Pelvic Floor Repair","code_information":[{"code":"3337082","type":"CDM"},{"code":"57545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2636,"maximum":4123,"gross_charge":4295,"discounted_cash":3866,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2706},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2663},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4080},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3994},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2636}]}]},{"description":"Dalbavancin 500 Mg Pow [Gmh]","code_information":[{"code":"4507059","type":"CDM"},{"code":"250","type":"RC"},{"code":"57970010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2633,"maximum":4118,"gross_charge":4290,"discounted_cash":3861,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2703},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2660},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4076},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3990},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2633},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2660}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Alemtuzumab 30mg/1ml Vial [Gmh]","code_information":[{"code":"CP17805909631288591","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468035703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2631,"maximum":4115,"gross_charge":4286,"discounted_cash":3857,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2700},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2657},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4072},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3986},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2631},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2657}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Removal of cataract with insertion of lens","code_information":[{"code":"CP17805909763613867","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"66984","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2624,"maximum":4104,"gross_charge":4275,"discounted_cash":3848,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2693},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2651},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4061},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3976},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2624}]}]},{"description":"Mri Chest W/ + W/o Cont","code_information":[{"code":"3760115-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"71552","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2578,"maximum":4032,"gross_charge":4200,"discounted_cash":3780,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2646},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4032},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2604},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3990},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3906},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2578}]}]},{"description":"Mra Head W/ + W/o Cont","code_information":[{"code":"3760114-TC","type":"CDM"},{"code":"618","type":"RC"},{"code":"70546","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2517,"maximum":3936,"gross_charge":4100,"discounted_cash":3690,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2583},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3936},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2542},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3895},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3813},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2517}]}]},{"description":"Mri Ue Joint W/ + W/o Cont Bil","code_information":[{"code":"3770191-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73223","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2517,"maximum":3936,"gross_charge":4100,"discounted_cash":3690,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2583},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3936},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2542},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3895},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3813},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2517}]}]},{"description":"Mri Ue Joint W/ + W/o Cont Lt","code_information":[{"code":"3770192-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73223","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2517,"maximum":3936,"gross_charge":4100,"discounted_cash":3690,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2583},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3936},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2542},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3895},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3813},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2517}]}]},{"description":"Mri Ue Joint W/ + W/o Cont Rt","code_information":[{"code":"3770193-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73223","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2517,"maximum":3936,"gross_charge":4100,"discounted_cash":3690,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2583},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3936},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2542},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3895},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3813},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2517}]}]},{"description":"Mrv Head W/ + W/o Cont","code_information":[{"code":"3770009","type":"CDM"},{"code":"618","type":"RC"},{"code":"70546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2517,"maximum":3936,"gross_charge":4100,"discounted_cash":3690,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2583},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3936},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2542},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3895},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3813},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2517}]}]},{"description":"57265 Combined Anterposterior Colporrhaphy With Enterocele Repair","code_information":[{"code":"3338004","type":"CDM"},{"code":"57265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2502,"maximum":3914,"gross_charge":4077,"discounted_cash":3669,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2569},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3914},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3873},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3792},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2502}]}]},{"description":"Naltrexone 380 Mg Pwd [Gmh]","code_information":[{"code":"4505038","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757030001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2502,"maximum":3914,"gross_charge":4077,"discounted_cash":3669,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2569},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3914},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3873},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3792},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2502},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2528}]}],"drug_information":{"unit":380,"type":"ME"}},{"description":"57540 Excision Of Cervical Stump; Abdominal Approach","code_information":[{"code":"3337081","type":"CDM"},{"code":"57540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2499,"maximum":3908,"gross_charge":4071,"discounted_cash":3664,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2565},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3908},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2524},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3867},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3786},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2499}]}]},{"description":"27267 Cltx Proximal End/head Femur W/o Man","code_information":[{"code":"3331924","type":"CDM"},{"code":"361","type":"RC"},{"code":"27267","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2489,"maximum":3893,"gross_charge":4055,"discounted_cash":3650,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2555},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3893},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2514},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3852},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3771},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2489}]}]},{"description":"58822 Drainage Of Ovarian Abscess; Abdominal Approach","code_information":[{"code":"3337138","type":"CDM"},{"code":"58822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2466,"maximum":3857,"gross_charge":4018,"discounted_cash":3616,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2531},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3857},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2491},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3817},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3737},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2466}]}]},{"description":"Mri Brain W/o Cont","code_information":[{"code":"3770010-TC","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2455,"maximum":3840,"gross_charge":4000,"discounted_cash":3600,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2520},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3840},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2455}]}]},{"description":"Mri Face Neck Orbit W/ Cont","code_information":[{"code":"3770048-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"70542","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2455,"maximum":3840,"gross_charge":4000,"discounted_cash":3600,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2520},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3840},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2455}]}]},{"description":"Mri Spine Cervical W/o Cont","code_information":[{"code":"3770020-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2455,"maximum":3840,"gross_charge":4000,"discounted_cash":3600,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2520},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3840},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2455}]}]},{"description":"Mri Spine Thoracic W/o Cont","code_information":[{"code":"3770025-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2455,"maximum":3840,"gross_charge":4000,"discounted_cash":3600,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2520},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3840},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3800},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2455}]}]},{"description":"Paclitaxel Protein-bound 100 Mg Pow [Gmh]","code_information":[{"code":"4507015","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517430001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2445,"maximum":3825,"gross_charge":3984,"discounted_cash":3586,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2510},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3825},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2470},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3785},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3705},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":2470}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"58825 Transposition, Ovary(s)","code_information":[{"code":"3337139","type":"CDM"},{"code":"58825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2433,"maximum":3805,"gross_charge":3964,"discounted_cash":3568,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2497},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3805},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2458},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3766},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3687},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2433}]}]},{"description":"64585 Removal Of Test Lead","code_information":[{"code":"3305100","type":"CDM"},{"code":"360","type":"RC"},{"code":"64585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2431,"maximum":3803,"gross_charge":3961,"discounted_cash":3565,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2495},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3803},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3763},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3684},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2431}]}]},{"description":"Polysomnogram W/ Cpap Sp","code_information":[{"code":"4100026-TC","type":"CDM"},{"code":"920","type":"RC"},{"code":"95808","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2427,"maximum":3796,"gross_charge":3954,"discounted_cash":3559,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2491},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3796},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2451},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3756},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3677},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2427}]}]},{"description":"Cetuximab 2 Mg/ml 200mg Sol [Gmh]","code_information":[{"code":"4507073","type":"CDM"},{"code":"250","type":"RC"},{"code":"66733095823","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2423,"maximum":3790,"gross_charge":3948,"discounted_cash":3553,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3790},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2448},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3751},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3672},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2423},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2448}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"58920 Wedge Resection Or Bisection Of Ovary, Unilateral Or Bilateral","code_information":[{"code":"3338009","type":"CDM"},{"code":"58920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2394,"maximum":3745,"gross_charge":3901,"discounted_cash":3511,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2458},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3745},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3706},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3628},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2394}]}]},{"description":"Ct Angio Chest +Abdomen +Pelvis W/runoff","code_information":[{"code":"3760102-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"75635","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2394,"maximum":3744,"gross_charge":3900,"discounted_cash":3510,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2457},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3744},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3705},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3627},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2394}]}]},{"description":"Mri Abdomen W/ Cont","code_information":[{"code":"3770072-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"74182","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2394,"maximum":3744,"gross_charge":3900,"discounted_cash":3510,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2457},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3744},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3705},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3627},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2394}]}]},{"description":"Mri Ue Non Joint W/ + W/o Cont Bil","code_information":[{"code":"3770064-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2394,"maximum":3744,"gross_charge":3900,"discounted_cash":3510,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2457},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3744},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3705},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3627},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2394}]}]},{"description":"Bortezomib 3.5mg Sdv [Gmh]","code_information":[{"code":"4502022","type":"CDM"},{"code":"250","type":"RC"},{"code":"63020004901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2392,"maximum":3741,"gross_charge":3897,"discounted_cash":3507,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2455},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3741},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2416},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3702},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3624},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2392},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2416}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"58740 Lysis Of Adhesion (Salpingolysis, Ovariolysis)","code_information":[{"code":"3337131","type":"CDM"},{"code":"58740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2387,"maximum":3733,"gross_charge":3889,"discounted_cash":3500,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2450},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3733},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2411},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3695},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3617},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2387}]}]},{"description":"Mri Le Joint W/ + W/o Cont Lt","code_information":[{"code":"3770186-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73723","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2378,"maximum":3720,"gross_charge":3875,"discounted_cash":3488,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3681},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2378}]}]},{"description":"Mri Le Joint W/ + W/o Cont Rt","code_information":[{"code":"3770187-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73723","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2378,"maximum":3720,"gross_charge":3875,"discounted_cash":3488,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3681},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2378}]}]},{"description":"Mri Le Joint W/ + W/o Cont Bil","code_information":[{"code":"3770185-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73723","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2378,"maximum":3720,"gross_charge":3875,"discounted_cash":3488,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3681},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2378}]}]},{"description":"Mri Le Non Joint W/ + W/o Cont Bil","code_information":[{"code":"3770062-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73723","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2378,"maximum":3720,"gross_charge":3875,"discounted_cash":3488,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3681},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2378}]}]},{"description":"Denosumab Bbdz 60 Mg/ml Sol [Gmh]","code_information":[{"code":"4507223","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314024063","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2375,"maximum":3715,"gross_charge":3870,"discounted_cash":3483,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2438},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3715},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2399},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3677},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3599},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2399}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Biopsy exam of esophagus, stomach or small bowel using an endoscope","code_information":[{"code":"CP17805909763615308","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2366,"maximum":3701,"gross_charge":3855,"discounted_cash":3470,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2429},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3701},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2390},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3662},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3585},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2366}]}]},{"description":"MRI scan of lower spinal canal","code_information":[{"code":"3770030-TC","type":"CDM"},{"code":"612","type":"RC"},{"code":"72148","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2363,"maximum":3696,"gross_charge":3850,"discounted_cash":3465,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2426},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3696},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2387},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3658},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2363}]}]},{"description":"Istent","code_information":[{"code":"4300400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2362,"maximum":3694,"gross_charge":3848,"discounted_cash":3463,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2424},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3694},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2386},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3656},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3579},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2362}]}]},{"description":"Left Istent","code_information":[{"code":"4300366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2362,"maximum":3694,"gross_charge":3848,"discounted_cash":3463,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2424},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3694},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2386},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3656},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3579},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2362}]}]},{"description":"Mra Head Venography W/o Cont","code_information":[{"code":"3760116-TC","type":"CDM"},{"code":"618","type":"RC"},{"code":"70544","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2332,"maximum":3648,"gross_charge":3800,"discounted_cash":3420,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3648},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3534},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2332}]}]},{"description":"Mri Chest W/o Cont","code_information":[{"code":"3760113-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"71550","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2332,"maximum":3648,"gross_charge":3800,"discounted_cash":3420,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3648},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3534},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2332}]}]},{"description":"Mri Le Joint W/ Cont Lt","code_information":[{"code":"3770061-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73722","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2332,"maximum":3648,"gross_charge":3800,"discounted_cash":3420,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3648},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3534},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2332}]}]},{"description":"Mri Pelvis W/ Cont","code_information":[{"code":"3770055-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"72196","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2332,"maximum":3648,"gross_charge":3800,"discounted_cash":3420,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3648},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3534},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2332}]}]},{"description":"Mri Ue Joint W/ Cont Lt","code_information":[{"code":"3770066-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73222","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2332,"maximum":3648,"gross_charge":3800,"discounted_cash":3420,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3648},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3534},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2332}]}]},{"description":"Mri Ue Joint W/ Cont Rt","code_information":[{"code":"3770067-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73222","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2332,"maximum":3648,"gross_charge":3800,"discounted_cash":3420,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3648},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3534},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2332}]}]},{"description":"Glaukos Istent Sightpath","code_information":[{"code":"4300999","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2332,"maximum":3648,"gross_charge":3800,"discounted_cash":3420,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3648},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2356},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3534},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2332}]}]},{"description":"Trastuzumab 150mg Mdv [Gmh]","code_information":[{"code":"4505098","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242013210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2326,"maximum":3638,"gross_charge":3790,"discounted_cash":3411,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2388},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3638},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2350},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3601},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3525},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2326},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2350}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"13160 Secondary Closure Surg Wound Exten/comp","code_information":[{"code":"3331907","type":"CDM"},{"code":"361","type":"RC"},{"code":"13160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2308,"maximum":3610,"gross_charge":3760,"discounted_cash":3384,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2369},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3610},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2331},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3572},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3497},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2308}]}]},{"description":"Mra Neck W/ Cont","code_information":[{"code":"3770084-TC","type":"CDM"},{"code":"615","type":"RC"},{"code":"70548","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2301,"maximum":3599,"gross_charge":3749,"discounted_cash":3374,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2362},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3599},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2324},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3562},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3487},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2301}]}]},{"description":"Removal of one knee cartilage using an endoscope","code_information":[{"code":"CP17805909763613912","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"29881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2289,"maximum":3581,"gross_charge":3730,"discounted_cash":3357,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2350},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3581},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2313},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3544},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3469},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2289}]}]},{"description":"Ct Angio Abdomen W/ + W/o Cont","code_information":[{"code":"3760099-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74175","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2286,"maximum":3576,"gross_charge":3725,"discounted_cash":3353,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3576},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3539},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3464},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2286}]}]},{"description":"58925 Ovarian Cystectomy, Unilateral Or Bilateral","code_information":[{"code":"3338010","type":"CDM"},{"code":"58925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2283,"maximum":3571,"gross_charge":3720,"discounted_cash":3348,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2344},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3571},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2306},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3534},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3460},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2283}]}]},{"description":"Paclitaxel 6 Mg/ml 50 Ml Vial [Gmh]","code_information":[{"code":"4505047","type":"CDM"},{"code":"250","type":"RC"},{"code":"00015347911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2273,"maximum":3555,"gross_charge":3703,"discounted_cash":3333,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2333},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3555},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3518},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3444},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2273},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2296}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Ferric Carboxymaltose (As Elemental Iron) 50 Mg/ml 15 Ml Sol [Gmh]","code_information":[{"code":"4505057","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517065001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2272,"maximum":3553,"gross_charge":3701,"discounted_cash":3331,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2332},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3553},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3516},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3442},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2272},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2295}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ct Angio Chest W/ Cont","code_information":[{"code":"3760105-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71275","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2271,"maximum":3552,"gross_charge":3700,"discounted_cash":3330,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3552},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2294},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3515},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3441},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2271}]}]},{"description":"Ct Angio Chest W/ + W/o Cont","code_information":[{"code":"3760095-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71275","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2271,"maximum":3552,"gross_charge":3700,"discounted_cash":3330,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3552},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2294},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3515},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3441},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2271}]}]},{"description":"Mri Le Joint W/ Cont Rt","code_information":[{"code":"3770063-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73722","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2271,"maximum":3552,"gross_charge":3700,"discounted_cash":3330,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3552},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2294},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3515},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3441},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2271}]}]},{"description":"Abatacept 250 Mg Pow [Gmh]","code_information":[{"code":"4507168","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003218713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2242,"maximum":3507,"gross_charge":3653,"discounted_cash":3288,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2301},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3507},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2265},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3470},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3397},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2242},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2265}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"57270 Repair Of Enterocele, Abdominal Approach","code_information":[{"code":"3337069","type":"CDM"},{"code":"57270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2241,"maximum":3505,"gross_charge":3651,"discounted_cash":3286,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2300},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3505},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3468},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2241}]}]},{"description":"99211 Removal Of Cadd Pump Charge","code_information":[{"code":"3655035","type":"CDM"},{"code":"761","type":"RC"},{"code":"36262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2234,"maximum":3494,"gross_charge":3640,"discounted_cash":3276,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2293},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3494},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2257},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3458},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3385},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2234}]}]},{"description":"Ma Stereotactic Loc Rt.","code_information":[{"code":"3720022-TC","type":"CDM"},{"code":"401","type":"RC"},{"code":"19081","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2210,"maximum":3456,"gross_charge":3600,"discounted_cash":3240,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3420},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3348},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2210}]}]},{"description":"Mri Face Neck Orbit W/o Cont","code_information":[{"code":"3770049-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"70540","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2210,"maximum":3456,"gross_charge":3600,"discounted_cash":3240,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3420},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3348},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2210}]}]},{"description":"58700 Salpingectomy, Complete Or Partial, Unilateral Or Bilateral","code_information":[{"code":"3338008","type":"CDM"},{"code":"58700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2210,"maximum":3456,"gross_charge":3600,"discounted_cash":3240,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3420},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3348},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2210}]}]},{"description":"Mra Neck W/o Cont","code_information":[{"code":"3770081-TC","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2194,"maximum":3432,"gross_charge":3575,"discounted_cash":3218,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2217},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3396},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2194}]}]},{"description":"59100 Hysterectomy, Abdominal","code_information":[{"code":"3338025","type":"CDM"},{"code":"59100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2167,"maximum":3390,"gross_charge":3531,"discounted_cash":3178,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2225},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3390},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2189},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3354},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3284},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2167}]}]},{"description":"Room/bed: Ob","code_information":[{"code":"3100012","type":"CDM"},{"code":"112","type":"RC"},{"code":"CP3100012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2158,"maximum":3374,"gross_charge":3515,"discounted_cash":3164,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":3374},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3339},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3269},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2158}]}]},{"description":"Ct Angio Head W/ + W/o Cont","code_information":[{"code":"3760107-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70496","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2148,"maximum":3360,"gross_charge":3500,"discounted_cash":3150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2148}]}]},{"description":"Ct Head Or Brain W/ + W/o Cont","code_information":[{"code":"3760074-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70470","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2148,"maximum":3360,"gross_charge":3500,"discounted_cash":3150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2148}]}]},{"description":"Ct Le W/ + W/o Cont Bil","code_information":[{"code":"3760125-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2148,"maximum":3360,"gross_charge":3500,"discounted_cash":3150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2148}]}]},{"description":"Ct Le W/ + W/o Cont Lt","code_information":[{"code":"3760123-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2148,"maximum":3360,"gross_charge":3500,"discounted_cash":3150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2148}]}]},{"description":"Ct Le W/ + W/o Cont Rt","code_information":[{"code":"3760124-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2148,"maximum":3360,"gross_charge":3500,"discounted_cash":3150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2148}]}]},{"description":"Mri Pelvis W/o Cont","code_information":[{"code":"3770057-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"72195","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2148,"maximum":3360,"gross_charge":3500,"discounted_cash":3150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2170},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3325},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3255},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2148}]}]},{"description":"59130 Surgical Treatment Of Ectopic Pregnancy, Abdominal Pregnancy","code_information":[{"code":"3338027","type":"CDM"},{"code":"59130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2135,"maximum":3340,"gross_charge":3479,"discounted_cash":3131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2192},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3305},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3235},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2135}]}]},{"description":"Ct Chest W/ + W/o Cont","code_information":[{"code":"3760081-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71270","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2133,"maximum":3336,"gross_charge":3475,"discounted_cash":3128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3336},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3301},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3232},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2133}]}]},{"description":"Removal of cataract with insertion of lens","code_information":[{"code":"3300500","type":"CDM"},{"code":"360","type":"RC"},{"code":"66984","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2128,"maximum":3328,"gross_charge":3467,"discounted_cash":3120,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2184},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3328},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2150},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3294},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2128}]}]},{"description":"Ct Angio Neck W/ + W/o Cont","code_information":[{"code":"3760108-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70498","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2118,"maximum":3312,"gross_charge":3450,"discounted_cash":3105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2139},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3278},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3209},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2118}]}]},{"description":"Mri Abdomen W/o Cont","code_information":[{"code":"3770070-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"74181","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2102,"maximum":3288,"gross_charge":3425,"discounted_cash":3083,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3254},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3185},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2102}]}]},{"description":"Ct Abdomen W/ + W/o Cont","code_information":[{"code":"3760080-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74170","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2087,"maximum":3264,"gross_charge":3400,"discounted_cash":3060,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3230},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3162},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2087}]}]},{"description":"Mra Abdomen W/ + W/o Cont","code_information":[{"code":"3770080-TC","type":"CDM"},{"code":"618","type":"RC"},{"code":"74185","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2087,"maximum":3264,"gross_charge":3400,"discounted_cash":3060,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3230},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3162},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2087}]}]},{"description":"Ct Spine Cervical W/ Cont","code_information":[{"code":"3760131-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72126","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2072,"maximum":3240,"gross_charge":3375,"discounted_cash":3038,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2093},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3206},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3139},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2072}]}]},{"description":"Hylan G-f 20 48 Mg/6 Ml Sol [Gmh]","code_information":[{"code":"4507027","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468009003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2030,"maximum":3175,"gross_charge":3307,"discounted_cash":2976,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2083},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2050},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3142},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3076},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2030},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2050}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Ct Angio Ue Lt","code_information":[{"code":"3700129-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73206","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2026,"maximum":3168,"gross_charge":3300,"discounted_cash":2970,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2079},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2046},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3135},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3069},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2026}]}]},{"description":"Ct Angio Ue Rt","code_information":[{"code":"3700130-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73206","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2026,"maximum":3168,"gross_charge":3300,"discounted_cash":2970,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2079},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2046},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3135},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3069},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2026}]}]},{"description":"Ct Pelvis W/ + W/o Cont","code_information":[{"code":"3760084-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72194","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":2026,"maximum":3168,"gross_charge":3300,"discounted_cash":2970,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2079},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2046},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3135},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3069},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2026}]}]},{"description":"49553 Repair Initial Femoral Hernia, Any Age Incarcerated Or Strangulated","code_information":[{"code":"3331343","type":"CDM"},{"code":"521","type":"RC"},{"code":"49553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2026,"maximum":3168,"gross_charge":3300,"discounted_cash":2970,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2079},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2046},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3135},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3069},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2026}]}]},{"description":"Leuprolide 22.5 Mg/3 Months Pwd (Eligard)[gmh]","code_information":[{"code":"4507007","type":"CDM"},{"code":"250","type":"RC"},{"code":"62935022710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2008,"maximum":3141,"gross_charge":3272,"discounted_cash":2945,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2061},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2029},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3108},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3043},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2008},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2029}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Mri Le Non Joint W/o Cont Bil","code_information":[{"code":"3770065-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73718","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1964,"maximum":3072,"gross_charge":3200,"discounted_cash":2880,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2016},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3072},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1984},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3040},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2976},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1964}]}]},{"description":"Ct Angio Head +Angio Neck W/ + W/o Cont","code_information":[{"code":"3760109-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"7049670498","type":"NDC","modifier":"TC"}],"standard_charges":[{"setting":"both","modifier_code":["TC"],"minimum":1937,"maximum":3030,"gross_charge":3156,"discounted_cash":2840,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1988},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3030},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1957},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2998},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2935},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1957}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"57555 Excision Of Cervical Stump, Vaginal Approach With Anterior And/or Posterior Approach","code_information":[{"code":"3337084","type":"CDM"},{"code":"57555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1925,"maximum":3011,"gross_charge":3136,"discounted_cash":2822,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1976},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3011},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1944},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2979},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2916},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1925}]}]},{"description":"Ct Angio Head + Perfusion","code_information":[{"code":"CP17805908877493841","type":"CDM"},{"code":"CP17805908877493841","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1903,"maximum":2976,"gross_charge":3100,"discounted_cash":2790,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1953},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2976},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1922},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2945},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2883},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1903}]}]},{"description":"Ct Soft Tissue Neck W/ + W/o Cont","code_information":[{"code":"3760082-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70492","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1903,"maximum":2976,"gross_charge":3100,"discounted_cash":2790,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1953},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2976},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1922},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2945},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2883},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1903}]}]},{"description":"CT scan of pelvis with contrast","code_information":[{"code":"3760073-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72193","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1867,"maximum":2920,"gross_charge":3042,"discounted_cash":2738,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1916},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2920},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1886},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2890},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2829},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1867}]}]},{"description":"Romiplostim 125 Mcg Pow [Gmh]","code_information":[{"code":"4507103","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513022301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1857,"maximum":2904,"gross_charge":3025,"discounted_cash":2723,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1906},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2904},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1876},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2874},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2813},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1857},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1876}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Smart Programmer Kit X (C)","code_information":[{"code":"4301943","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301943","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1843,"maximum":2883,"gross_charge":3003,"discounted_cash":2703,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1892},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2883},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1862},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2853},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2793},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1843}]}]},{"description":"Ct Abdomen W/ Cont","code_information":[{"code":"3760091-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74160","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Angio Le Bil","code_information":[{"code":"3700126-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73706","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Angio Le Lt","code_information":[{"code":"3700127-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73706","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Angio Le Rt","code_information":[{"code":"3700128-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73706","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Liver Biopsy","code_information":[{"code":"3760132-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"47000","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Spine Cervical W/ + W/o Cont","code_information":[{"code":"3760130-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72127","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Spine Lumbar W/ Cont","code_information":[{"code":"3760122-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72132","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Ue W/ Cont Lt","code_information":[{"code":"3760063-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Mri Ue Non Joint W/o Cont Bil","code_information":[{"code":"3770060-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73218","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Cannulated Hex Screwdriver 314.29","code_information":[{"code":"4309959","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309959","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1841,"maximum":2880,"gross_charge":3000,"discounted_cash":2700,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2850},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1841}]}]},{"description":"Ct Spine Thoracic W/ + W/o Cont","code_information":[{"code":"3760118-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72130","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1823,"maximum":2851,"gross_charge":2970,"discounted_cash":2673,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1871},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2851},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2822},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2762},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1823}]}]},{"description":"64488transversus Abdominis Plane (Tap) Block (Abdominal Plane Block, Rectus Sheath Block) Bilater","code_information":[{"code":"3500131","type":"CDM"},{"code":"370","type":"RC"},{"code":"64488","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1811,"maximum":2832,"gross_charge":2950,"discounted_cash":2655,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1859},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2832},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1829},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2803},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2744},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1811}]}]},{"description":"57556 Excision Of Cervical Stump, Vaginal Approach With Repair Of Enterocele","code_information":[{"code":"3337085","type":"CDM"},{"code":"57556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1811,"maximum":2832,"gross_charge":2950,"discounted_cash":2655,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1859},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2832},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1829},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2803},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2744},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1811}]}]},{"description":"Ct Sinus Or Facial W/ + W/o Cont","code_information":[{"code":"3760098-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70488","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1780,"maximum":2784,"gross_charge":2900,"discounted_cash":2610,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1827},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2784},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1798},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2755},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2697},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1780}]}]},{"description":"Ct Spine Lumbar W/ + W/o Cont","code_information":[{"code":"3760121-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72133","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1780,"maximum":2784,"gross_charge":2900,"discounted_cash":2610,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1827},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2784},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1798},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2755},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2697},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1780}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"3770068-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73721","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1780,"maximum":2784,"gross_charge":2900,"discounted_cash":2610,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1827},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2784},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1798},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2755},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2697},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1780}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"3770188-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73721","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1780,"maximum":2784,"gross_charge":2900,"discounted_cash":2610,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1827},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2784},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1798},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2755},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2697},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1780}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"3770189-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73721","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1780,"maximum":2784,"gross_charge":2900,"discounted_cash":2610,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1827},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2784},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1798},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2755},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2697},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1780}]}]},{"description":"MRI scan of leg joint","code_information":[{"code":"3770190-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73721","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1780,"maximum":2784,"gross_charge":2900,"discounted_cash":2610,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1827},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2784},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1798},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2755},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2697},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1780}]}]},{"description":"Mri Ue Joint W/o Cont Bil","code_information":[{"code":"3770194-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73221","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1765,"maximum":2760,"gross_charge":2875,"discounted_cash":2588,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1811},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2760},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1783},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2731},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2674},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1765}]}]},{"description":"Mri Ue Joint W/o Cont Lt","code_information":[{"code":"3770196-TC","type":"CDM"},{"code":"614","type":"RC"},{"code":"73221","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1765,"maximum":2760,"gross_charge":2875,"discounted_cash":2588,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1811},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2760},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1783},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2731},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2674},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1765}]}]},{"description":"57300 Closure Of Rectovaginal Fistula; Vaginal Or Transanal Approach","code_information":[{"code":"3337039","type":"CDM"},{"code":"57300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1761,"maximum":2754,"gross_charge":2869,"discounted_cash":2582,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1807},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2754},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1779},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2726},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2668},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1761}]}]},{"description":"Curosurf 240mg/3ml (Poractant Alfa) (Surfactant) Refrigerator [Gmh]","code_information":[{"code":"4504019","type":"CDM"},{"code":"250","type":"RC"},{"code":"10122051003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1752,"maximum":2741,"gross_charge":2855,"discounted_cash":2570,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1799},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2741},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1770},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2712},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2655},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1752},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1770}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Ct Chest W/ Cont","code_information":[{"code":"3760077-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71260","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1749,"maximum":2736,"gross_charge":2850,"discounted_cash":2565,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1796},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2736},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1767},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2708},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2651},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1749}]}]},{"description":"Bottle To Bottle Hose","code_information":[{"code":"4305513","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305513","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1749,"maximum":2735,"gross_charge":2849,"discounted_cash":2564,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1795},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2735},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1766},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2707},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2650},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1749}]}]},{"description":"Infliximab 100 Mg Iv Inj (Remicade Brand Name) [Gmh]","code_information":[{"code":"4501063","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1733,"maximum":2710,"gross_charge":2823,"discounted_cash":2541,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1778},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2710},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1750},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2682},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2625},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1733},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1750}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Darbepoetin Alfa 150 Mcg/0.3 Ml Inj Sol [Gmh]","code_information":[{"code":"4504003","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1722,"maximum":2694,"gross_charge":2806,"discounted_cash":2525,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1768},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2694},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1740},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2666},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2610},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1722},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1740}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"38222 Diagnostic Bone Marrow; Biopsy(ies) And Aspiration(s)","code_information":[{"code":"3331992","type":"CDM"},{"code":"361","type":"RC"},{"code":"38222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1719,"maximum":2688,"gross_charge":2800,"discounted_cash":2520,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1764},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2688},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1736},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2660},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1719}]}]},{"description":"Ct Iac W/ + W/o Cont","code_information":[{"code":"3760120-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70482","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1719,"maximum":2688,"gross_charge":2800,"discounted_cash":2520,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1764},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2688},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1736},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2660},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1719}]}]},{"description":"Ct Le W/ Cont Lt","code_information":[{"code":"3760061-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1719,"maximum":2688,"gross_charge":2800,"discounted_cash":2520,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1764},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2688},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1736},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2660},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1719}]}]},{"description":"Ct Orbit Sella Etc. W/ + W/o Cont","code_information":[{"code":"3760094-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70482","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1719,"maximum":2688,"gross_charge":2800,"discounted_cash":2520,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1764},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2688},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1736},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2660},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1719}]}]},{"description":"Speed Bridge Kit","code_information":[{"code":"4301122","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301122","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1709,"maximum":2673,"gross_charge":2784,"discounted_cash":2506,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1754},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2673},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1726},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2645},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2589},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1709}]}]},{"description":"Sodium Hyaluronate 30 Mg/3 Ml Sol [Gmh]","code_information":[{"code":"4506059","type":"CDM"},{"code":"250","type":"RC"},{"code":"87541030091","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1706,"maximum":2669,"gross_charge":2780,"discounted_cash":2502,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1751},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2669},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1724},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2641},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2585},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1706},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1724}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Us Breast Biopsy Lt","code_information":[{"code":"4020018-LT","type":"CDM"},{"code":"401","type":"RC"},{"code":"19083","type":"CPT","modifier":"LT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["LT"],"minimum":1703,"maximum":2664,"gross_charge":2775,"discounted_cash":2498,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1748},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2664},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1721},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1703}]}]},{"description":"Us Breast Biopsy Rt","code_information":[{"code":"4020019-RT","type":"CDM"},{"code":"401","type":"RC"},{"code":"19083","type":"CPT","modifier":"RT"}],"standard_charges":[{"setting":"outpatient","modifier_code":["RT"],"minimum":1703,"maximum":2664,"gross_charge":2775,"discounted_cash":2498,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1748},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2664},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1721},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1703}]}]},{"description":"Us Breast Biopsy Bil.","code_information":[{"code":"3740023-50","type":"CDM"},{"code":"401","type":"RC"},{"code":"19083","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":1703,"maximum":2664,"gross_charge":2775,"discounted_cash":2498,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1748},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2664},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1721},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2636},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1703}]}]},{"description":"Ct Soft Tissue Neck W/ Cont","code_information":[{"code":"3760093-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70491","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1688,"maximum":2640,"gross_charge":2750,"discounted_cash":2475,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1733},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2640},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1705},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2613},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2558},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1688}]}]},{"description":"Ct Spine Cervical W/o Cont","code_information":[{"code":"3760088-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72125","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1673,"maximum":2616,"gross_charge":2725,"discounted_cash":2453,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1717},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2616},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1690},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2589},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2534},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1673}]}]},{"description":"Ct Spine Thoracic W/o Cont","code_information":[{"code":"3760089-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72128","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1673,"maximum":2616,"gross_charge":2725,"discounted_cash":2453,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1717},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2616},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1690},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2589},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2534},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1673}]}]},{"description":"Ct Abdomen W/o Cont","code_information":[{"code":"3760071-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"74150","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1657,"maximum":2592,"gross_charge":2700,"discounted_cash":2430,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1701},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2592},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1674},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2565},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2511},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1657}]}]},{"description":"Ct Iac W/ Cont","code_information":[{"code":"3760087-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70481","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1657,"maximum":2592,"gross_charge":2700,"discounted_cash":2430,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1701},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2592},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1674},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2565},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2511},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1657}]}]},{"description":"Ct Orbit Sella Etc. W/ Cont","code_information":[{"code":"3760096-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70481","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1657,"maximum":2592,"gross_charge":2700,"discounted_cash":2430,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1701},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2592},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1674},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2565},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2511},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1657}]}]},{"description":"Ct Spine Lumbar W/o Cont","code_information":[{"code":"3760090-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72131","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1657,"maximum":2592,"gross_charge":2700,"discounted_cash":2430,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1701},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2592},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1674},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2565},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2511},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1657}]}]},{"description":"Ct Spine Thoracic W/ Cont","code_information":[{"code":"3760117-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72129","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1657,"maximum":2592,"gross_charge":2700,"discounted_cash":2430,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1701},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2592},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1674},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2565},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2511},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1657}]}]},{"description":"Internal Brace (C)","code_information":[{"code":"4301135","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301135","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1652,"maximum":2583,"gross_charge":2691,"discounted_cash":2422,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1695},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2583},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1668},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2556},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2503},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1652}]}]},{"description":"Allograft 7.5mm X 280mm","code_information":[{"code":"4300265","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300265","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1646,"maximum":2575,"gross_charge":2682,"discounted_cash":2414,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1690},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2575},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1663},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2548},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2494},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1646}]}]},{"description":"Ct Pelvis W/o Cont","code_information":[{"code":"3760076-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"72192","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1642,"maximum":2568,"gross_charge":2675,"discounted_cash":2408,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2568},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1659},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2541},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2488},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1642}]}]},{"description":"64415brachial Plexus, Single","code_information":[{"code":"3500129","type":"CDM"},{"code":"370","type":"RC"},{"code":"64415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1639,"maximum":2564,"gross_charge":2671,"discounted_cash":2404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1683},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2564},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1656},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2537},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2484},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1639}]}]},{"description":"64416brachial Plexus, Continuous Infusion By Catheter (Including Catheter Placement)","code_information":[{"code":"3500133","type":"CDM"},{"code":"370","type":"RC"},{"code":"64416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1639,"maximum":2564,"gross_charge":2671,"discounted_cash":2404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1683},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2564},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1656},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2537},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2484},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1639}]}]},{"description":"64417axillary Nerve","code_information":[{"code":"3500115","type":"CDM"},{"code":"370","type":"RC"},{"code":"64417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1639,"maximum":2564,"gross_charge":2671,"discounted_cash":2404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1683},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2564},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1656},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2537},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2484},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1639}]}]},{"description":"64450 N Block Other Peripheral .","code_information":[{"code":"3332422","type":"CDM"},{"code":"370","type":"RC"},{"code":"64450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1639,"maximum":2564,"gross_charge":2671,"discounted_cash":2404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1683},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2564},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1656},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2537},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2484},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1639}]}]},{"description":"Ct Chest W/o Cont","code_information":[{"code":"3760078-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71250","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1627,"maximum":2544,"gross_charge":2650,"discounted_cash":2385,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1670},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2544},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1643},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2518},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1627}]}]},{"description":"Reslizumab 100 Mg/ 10 Ml Sol [Gmh]","code_information":[{"code":"4507202","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310061031","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1621,"maximum":2535,"gross_charge":2641,"discounted_cash":2377,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1664},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2535},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1637},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2509},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2456},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1621},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1637}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Zoledronic Acid 5 Mg/100 Ml Sol [Gmh]","code_information":[{"code":"4505024","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078043561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1609,"maximum":2517,"gross_charge":2622,"discounted_cash":2360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1652},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2517},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1626},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2491},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2438},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1609},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1626}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ct Head Or Brain W/ Cont","code_information":[{"code":"3760092-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70460","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1596,"maximum":2496,"gross_charge":2600,"discounted_cash":2340,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1638},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2496},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1612},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2470},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1596}]}]},{"description":"Ct Iac W/o Cont","code_information":[{"code":"3760119-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70480","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1596,"maximum":2496,"gross_charge":2600,"discounted_cash":2340,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1638},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2496},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1612},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2470},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1596}]}]},{"description":"Ct Sinus Or Facial W/ Cont","code_information":[{"code":"3760097-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70487","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1596,"maximum":2496,"gross_charge":2600,"discounted_cash":2340,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1638},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2496},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1612},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2470},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1596}]}]},{"description":"Ivantis Hydrus Microstent ( Sightpath )","code_information":[{"code":"4300934","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300934","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1586,"maximum":2481,"gross_charge":2584,"discounted_cash":2326,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1628},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2481},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1602},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2455},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2403},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1586}]}]},{"description":"C-qur Mesh 10 X 14","code_information":[{"code":"4300783","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300783","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1571,"maximum":2457,"gross_charge":2559,"discounted_cash":2303,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1612},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2457},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1587},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2431},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2380},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1571}]}]},{"description":"Ct Le W/o Cont Lt","code_information":[{"code":"3760062-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73700","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1565,"maximum":2448,"gross_charge":2550,"discounted_cash":2295,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1607},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2448},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1581},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2423},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1565}]}]},{"description":"Us Echo 2d Comp","code_information":[{"code":"4040015-TC","type":"CDM"},{"code":"483","type":"RC"},{"code":"93306","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1565,"maximum":2448,"gross_charge":2550,"discounted_cash":2295,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1607},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2448},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1581},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2423},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1565}]}]},{"description":"Mirena Intrauterine System","code_information":[{"code":"3332303","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1562,"maximum":2443,"gross_charge":2545,"discounted_cash":2291,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1603},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2443},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1578},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2418},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2367},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1562}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Forefoot Internal Brace Kit","code_information":[{"code":"4301141","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301141","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1541,"maximum":2411,"gross_charge":2511,"discounted_cash":2260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1582},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2411},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1557},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2385},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2335},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1541}]}]},{"description":"Jada System (C)","code_information":[{"code":"4300277","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300277","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1541,"maximum":2411,"gross_charge":2511,"discounted_cash":2260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1582},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2411},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1557},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2385},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2335},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1541}]}]},{"description":"Delivery Charge","code_information":[{"code":"3450010","type":"CDM"},{"code":"722","type":"RC"},{"code":"CP3450010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1535,"maximum":2400,"gross_charge":2500,"discounted_cash":2250,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1575},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1550},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2325},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1535}]}]},{"description":"Ct Biopsy","code_information":[{"code":"3760137-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1535,"maximum":2400,"gross_charge":2500,"discounted_cash":2250,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1575},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1550},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2325},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1535}]}]},{"description":"Ct Guide Ndl Placement","code_information":[{"code":"3760138","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1535,"maximum":2400,"gross_charge":2500,"discounted_cash":2250,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1575},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1550},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2325},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1535}]}]},{"description":"Us Liver Biopsy","code_information":[{"code":"3740017","type":"CDM"},{"code":"402","type":"RC"},{"code":"47000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1535,"maximum":2400,"gross_charge":2500,"discounted_cash":2250,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1575},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2400},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1550},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2375},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2325},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1535}]}]},{"description":"J7296 Kyleena Iud.","code_information":[{"code":"3332327","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1492,"maximum":2333,"gross_charge":2430,"discounted_cash":2187,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1531},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2333},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1507},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2309},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1492}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nm Heart Image (3d) Single Tomographic Spect Multi Study At Rest Of Stress","code_information":[{"code":"4060037","type":"CDM"},{"code":"341","type":"RC"},{"code":"78451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1488,"maximum":2328,"gross_charge":2425,"discounted_cash":2183,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1528},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2328},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1504},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2304},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2255},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1488}]}]},{"description":"Nm Bone Imaging 3 Phase","code_information":[{"code":"4067600-TC","type":"CDM"},{"code":"341","type":"RC"},{"code":"78315","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1487,"maximum":2326,"gross_charge":2423,"discounted_cash":2181,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1526},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1502},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2302},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2253},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1487}]}]},{"description":"58900 Biopsy Of Ovary, Unilateral Or Bilateral","code_information":[{"code":"3337140","type":"CDM"},{"code":"58900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1487,"maximum":2326,"gross_charge":2423,"discounted_cash":2181,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1526},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1502},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2302},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2253},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1487}]}]},{"description":"Nm Bone Imagine 3 Phase","code_information":[{"code":"4067600","type":"CDM"},{"code":"341","type":"RC"},{"code":"78315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1473,"maximum":2304,"gross_charge":2400,"discounted_cash":2160,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1512},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1488},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2280},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1473}]}]},{"description":"Ct Soft Tissue Neck W/o Contrast","code_information":[{"code":"3760086-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70490","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1473,"maximum":2304,"gross_charge":2400,"discounted_cash":2160,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1512},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1488},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2280},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1473}]}]},{"description":"Ct Ue W/o Cont Lt","code_information":[{"code":"3760064-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1473,"maximum":2304,"gross_charge":2400,"discounted_cash":2160,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1512},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1488},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2280},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2232},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1473}]}]},{"description":"57268 Repair Of Enterocele, Vaginal Approach","code_information":[{"code":"3337068","type":"CDM"},{"code":"57268","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1453,"maximum":2272,"gross_charge":2367,"discounted_cash":2130,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1491},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1468},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2249},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2201},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1453}]}]},{"description":"11044 Debridement Skin, Sq Tissue, Muscle, Bon Tech Fee","code_information":[{"code":"3331887","type":"CDM"},{"code":"361","type":"RC"},{"code":"11044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1440,"maximum":2252,"gross_charge":2346,"discounted_cash":2111,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1478},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2252},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1455},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2182},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1440}]}]},{"description":"57320 Closure Of Vesicovaginal Fistula; Vaginal Approach","code_information":[{"code":"3337044","type":"CDM"},{"code":"57320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1435,"maximum":2244,"gross_charge":2338,"discounted_cash":2104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2244},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2221},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2174},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1435}]}]},{"description":"Novasure St Device Kit","code_information":[{"code":"4309031","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1428,"maximum":2234,"gross_charge":2327,"discounted_cash":2094,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1466},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1443},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2211},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2164},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1428}]}]},{"description":"J7307 Nexplanon","code_information":[{"code":"3332300","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1420,"maximum":2220,"gross_charge":2313,"discounted_cash":2082,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1457},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2220},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2197},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2151},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1420}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"59150 Treat Ectopic Pregnancy .","code_information":[{"code":"CP17805908878498491","type":"CDM"},{"code":"CP17805908878498491","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1418,"maximum":2218,"gross_charge":2310,"discounted_cash":2079,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1455},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2218},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2148},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1418}]}]},{"description":"64479 Anesth Injection(s) Anesthetic Agent And/or Steriod, Transforaminal Epidural, With Imaging Gui","code_information":[{"code":"3500168","type":"CDM"},{"code":"370","type":"RC"},{"code":"64479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1416,"maximum":2215,"gross_charge":2307,"discounted_cash":2076,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1453},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2215},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1430},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2192},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2146},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1416}]}]},{"description":"Rituxan 100mg/10ml Vial (Rituximab) [Gmh]","code_information":[{"code":"4502010","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242005121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1415,"maximum":2213,"gross_charge":2305,"discounted_cash":2075,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1452},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2213},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1429},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2144},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1415},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1429}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ct Abdomen Biopsy","code_information":[{"code":"3760136","type":"CDM"},{"code":"350","type":"RC"},{"code":"49180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1412,"maximum":2208,"gross_charge":2300,"discounted_cash":2070,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1449},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1426},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2185},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2139},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1412}]}]},{"description":"Ct Bone Density Study","code_information":[{"code":"3760133-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"49180","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1412,"maximum":2208,"gross_charge":2300,"discounted_cash":2070,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1449},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1426},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2185},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2139},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1412}]}]},{"description":"CT scan","code_information":[{"code":"3760085-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70450","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1412,"maximum":2208,"gross_charge":2300,"discounted_cash":2070,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1449},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1426},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2185},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2139},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1412}]}]},{"description":"Us Abdomen Biopsy","code_information":[{"code":"3740020","type":"CDM"},{"code":"402","type":"RC"},{"code":"49180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1412,"maximum":2208,"gross_charge":2300,"discounted_cash":2070,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1449},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1426},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2185},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2139},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1412}]}]},{"description":"58670 Laparoscopy, Surgical; With Fulguration Of Oviducts (With Or Without Transection)","code_information":[{"code":"3333216","type":"CDM"},{"code":"58670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1412,"maximum":2208,"gross_charge":2300,"discounted_cash":2070,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1449},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1426},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2185},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2139},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1412}]}]},{"description":"Infliximab Dyyb 100 Mg Pow [Gmh]","code_information":[{"code":"4507137","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069080901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1406,"maximum":2199,"gross_charge":2291,"discounted_cash":2062,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1443},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2199},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1420},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2176},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2131},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1406},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1420}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Triamcinolone Ophthalmic 40 Mg/ml Sus [Gmh]","code_information":[{"code":"4506076","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065054301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1403,"maximum":2195,"gross_charge":2286,"discounted_cash":2057,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1417},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2172},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1403},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1417}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Immune Globulin Intravenous 10%  5 Gm Sol [Gmh]","code_information":[{"code":"4505041","type":"CDM"},{"code":"250","type":"RC"},{"code":"44206043605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1399,"maximum":2188,"gross_charge":2279,"discounted_cash":2051,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1436},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2188},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1413},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2165},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2119},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1399},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1413}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Intrauterine Copper Contraceptive Charge","code_information":[{"code":"3332301","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1398,"maximum":2187,"gross_charge":2278,"discounted_cash":2050,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1435},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1412},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2164},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2119},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1398}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"10140 I&d Hematoma Seroma/fluid Collection Techfee","code_information":[{"code":"3331884","type":"CDM"},{"code":"361","type":"RC"},{"code":"10140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1384,"maximum":2164,"gross_charge":2254,"discounted_cash":2029,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1420},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1397},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2141},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2096},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1384}]}]},{"description":"Zoledronic Acid 4 Mg/ 5 Ml Soln [Gmh]","code_information":[{"code":"4501167","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078038725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1371,"maximum":2145,"gross_charge":2234,"discounted_cash":2011,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1407},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2145},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1385},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2122},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2078},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1371},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1385}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Vaginal Hysterectomy, For Uterus 250g Or Less","code_information":[{"code":"CP17805908878019097","type":"CDM"},{"code":"CP17805908878019097","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1351,"maximum":2113,"gross_charge":2201,"discounted_cash":1981,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1387},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1365},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2091},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2047},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1351}]}]},{"description":"Nm Lung Quantification Study","code_information":[{"code":"4060029","type":"CDM"},{"code":"341","type":"RC"},{"code":"78598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1350,"maximum":2112,"gross_charge":2200,"discounted_cash":1980,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1386},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1364},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2090},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2046},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1350}]}]},{"description":"Ct Sinus Or Facial W/o Cont","code_information":[{"code":"3760070-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"70486","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1350,"maximum":2112,"gross_charge":2200,"discounted_cash":1980,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1386},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1364},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2090},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2046},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1350}]}]},{"description":"Injection(s) of therapeutic substance","code_information":[{"code":"CP17805909763619915","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1320,"maximum":2064,"gross_charge":2150,"discounted_cash":1935,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1355},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2064},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1333},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2043},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1320}]}]},{"description":"Injection(s) of anesthetic into lower spine using imaging guidance","code_information":[{"code":"CP17805909763619432","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1320,"maximum":2064,"gross_charge":2150,"discounted_cash":1935,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1355},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2064},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1333},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2043},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2000},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1320}]}]},{"description":"57550 Excision Of Cervical Stump, Vaginal Approach","code_information":[{"code":"3337083","type":"CDM"},{"code":"57550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1305,"maximum":2041,"gross_charge":2126,"discounted_cash":1913,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1339},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2041},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2020},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1977},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1305}]}]},{"description":"J7301 Skyla Iud.","code_information":[{"code":"3332302","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1301,"maximum":2034,"gross_charge":2119,"discounted_cash":1907,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1335},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2034},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1314},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2013},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1971},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1301}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nm Pulmonary Ventilation/perfusion Imaging","code_information":[{"code":"4060028","type":"CDM"},{"code":"341","type":"RC"},{"code":"78582","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1289,"maximum":2016,"gross_charge":2100,"discounted_cash":1890,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1323},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2016},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1953},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1289}]}]},{"description":"Mid-urethral Sling","code_information":[{"code":"4309033","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1282,"maximum":2004,"gross_charge":2088,"discounted_cash":1879,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2004},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1984},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1942},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1282}]}]},{"description":"Puraplyam Mz 500mg","code_information":[{"code":"4308118","type":"CDM"},{"code":"636","type":"RC"},{"code":"CP4308118","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1282,"maximum":2004,"gross_charge":2088,"discounted_cash":1879,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2004},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1984},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1942},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1282}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"57130 Excision Of Vaginal Septum","code_information":[{"code":"3337057","type":"CDM"},{"code":"57130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1279,"maximum":2001,"gross_charge":2084,"discounted_cash":1876,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1313},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2001},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1292},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1980},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1938},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1279}]}]},{"description":"57310 Closure Of Urethrovaginal Fistula","code_information":[{"code":"3337042","type":"CDM"},{"code":"57310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1279,"maximum":2001,"gross_charge":2084,"discounted_cash":1876,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1313},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2001},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1292},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1980},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1938},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1279}]}]},{"description":"Aqueous Shunt Non Valve Express ( Sightpath )","code_information":[{"code":"4300992","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300992","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1276,"maximum":1996,"gross_charge":2079,"discounted_cash":1871,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1310},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1996},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1289},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1975},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1933},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1276}]}]},{"description":"64445 Anesth Sciatic Nerve, Single","code_information":[{"code":"3504445","type":"CDM"},{"code":"370","type":"RC"},{"code":"64445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1275,"maximum":1995,"gross_charge":2078,"discounted_cash":1870,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1309},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1974},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1933},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1275}]}]},{"description":"64446sciatic Nerve, Continuous Infusion By Catheter (Including Catheter Placment)","code_information":[{"code":"3500134","type":"CDM"},{"code":"370","type":"RC"},{"code":"64446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1275,"maximum":1995,"gross_charge":2078,"discounted_cash":1870,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1309},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1974},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1933},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1275}]}]},{"description":"64448 Anesth Femoral Nerve, Continuous Infusion By Catheter (Including Catheter Placement)","code_information":[{"code":"3504448","type":"CDM"},{"code":"370","type":"RC"},{"code":"64448","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1275,"maximum":1995,"gross_charge":2078,"discounted_cash":1870,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1309},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1974},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1933},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1275}]}]},{"description":"64486transversus Abdominis Plane (Tap) Block Unilateral","code_information":[{"code":"3500124","type":"CDM"},{"code":"370","type":"RC"},{"code":"64486","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1275,"maximum":1995,"gross_charge":2078,"discounted_cash":1870,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1309},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1995},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1974},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1933},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1275}]}]},{"description":"Nm Hepatobillary Imag W/wo Gbef","code_information":[{"code":"4060066","type":"CDM"},{"code":"341","type":"RC"},{"code":"78227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1274,"maximum":1992,"gross_charge":2075,"discounted_cash":1868,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1992},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1287},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1971},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1930},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1274}]}]},{"description":"Nm Bone Imaging Whole Body","code_information":[{"code":"4067528-TC","type":"CDM"},{"code":"340","type":"RC"},{"code":"78306","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1261,"maximum":1973,"gross_charge":2055,"discounted_cash":1850,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1295},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1973},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1274},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1952},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1911},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1261}]}]},{"description":"59870 Uterine Evacuation And Curettage For Hydatidiform Mole","code_information":[{"code":"3338032","type":"CDM"},{"code":"59870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1248,"maximum":1953,"gross_charge":2034,"discounted_cash":1831,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1281},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1953},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1261},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1932},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1892},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1248}]}]},{"description":"G0390 Trauma Team Response Charge","code_information":[{"code":"3610528","type":"CDM"},{"code":"684","type":"RC"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1248,"maximum":1952,"gross_charge":2033,"discounted_cash":1830,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1281},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1952},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1931},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1891},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1248}]}]},{"description":"Trauma Team Activation Charge","code_information":[{"code":"3610525","type":"CDM"},{"code":"684","type":"RC"},{"code":"CP3610525","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1248,"maximum":1952,"gross_charge":2033,"discounted_cash":1830,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1281},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1952},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1931},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1891},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1248}]}]},{"description":"Nm Whole Body Bone Scan","code_information":[{"code":"4067528","type":"CDM"},{"code":"341","type":"RC"},{"code":"78306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1243,"maximum":1944,"gross_charge":2025,"discounted_cash":1823,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1276},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1944},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1256},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1924},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1883},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1243}]}]},{"description":"64447 Anesth Femoral Nerve, Single","code_information":[{"code":"3504447","type":"CDM"},{"code":"370","type":"RC"},{"code":"64447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1239,"maximum":1937,"gross_charge":2018,"discounted_cash":1816,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1271},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1937},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1251},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1917},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1877},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1239}]}]},{"description":"57010 Colpotomy; With Exploration With Drainage Of Pelvic Abscess","code_information":[{"code":"3337021","type":"CDM"},{"code":"57010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1236,"maximum":1932,"gross_charge":2013,"discounted_cash":1812,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1932},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1912},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1872},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1236}]}]},{"description":"Ct Chest Low Dose Screen W/o Cont","code_information":[{"code":"3760104-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"71271","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1234,"maximum":1931,"gross_charge":2011,"discounted_cash":1810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1267},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1931},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1247},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1910},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1870},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1234}]}]},{"description":"Nm Acute Venous Thrombosis Imaging, Peptide","code_information":[{"code":"4060036","type":"CDM"},{"code":"341","type":"RC"},{"code":"78456","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1228,"maximum":1920,"gross_charge":2000,"discounted_cash":1800,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1260},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1920},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1900},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1228}]}]},{"description":"38221 Bone Marrow Biopsy","code_information":[{"code":"3331991","type":"CDM"},{"code":"361","type":"RC"},{"code":"38221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1228,"maximum":1920,"gross_charge":2000,"discounted_cash":1800,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1260},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1920},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1900},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1228}]}]},{"description":"Titanium Tacker 5mm (C)","code_information":[{"code":"4300872","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300872","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1228,"maximum":1920,"gross_charge":2000,"discounted_cash":1800,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1260},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1920},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1900},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1228}]}]},{"description":"Cetuximab 2 Mg/ml 100 Mg Sol [Gmh]","code_information":[{"code":"4507074","type":"CDM"},{"code":"250","type":"RC"},{"code":"66733094823","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1227,"maximum":1919,"gross_charge":1999,"discounted_cash":1799,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1259},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1919},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1239},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1899},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1859},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1227},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1239}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Pemetrexed 100 Mg Pow[gmh]","code_information":[{"code":"4505018","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002764001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1222,"maximum":1911,"gross_charge":1991,"discounted_cash":1792,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1254},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1911},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1891},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1852},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1222},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1234}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Prothrombin Complexpow1,000u [Gmh]","code_information":[{"code":"4505092","type":"CDM"},{"code":"250","type":"RC"},{"code":"63833038702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1218,"maximum":1905,"gross_charge":1984,"discounted_cash":1786,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1250},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1905},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1885},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1218},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1230}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Prothrombin Complexpow500u  [Gmh]","code_information":[{"code":"4505091","type":"CDM"},{"code":"250","type":"RC"},{"code":"63833038602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1218,"maximum":1905,"gross_charge":1984,"discounted_cash":1786,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1250},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1905},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1885},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1218},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1230}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Posterior Colporrhaphy; Repair Rectocele W/ Or W/o Perineorrhaphy Charge","code_information":[{"code":"CP17805908878005520","type":"CDM"},{"code":"CP17805908878005520","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1217,"maximum":1903,"gross_charge":1982,"discounted_cash":1784,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1249},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1903},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1883},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1843},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1217}]}]},{"description":"Vessica Insitu Sling Kit","code_information":[{"code":"4308903","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308903","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1209,"maximum":1891,"gross_charge":1970,"discounted_cash":1773,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1891},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1221},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1872},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1832},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1209}]}]},{"description":"Plantar Fascia Endoblade","code_information":[{"code":"4302071","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302071","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1209,"maximum":1890,"gross_charge":1969,"discounted_cash":1772,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1240},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1890},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1221},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1871},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1831},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1209}]}]},{"description":"Cataract W/astigmatism Tecnis Syngergy Toric ( Sightpath )","code_information":[{"code":"4300986","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300986","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1197,"maximum":1872,"gross_charge":1950,"discounted_cash":1755,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1229},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1872},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1209},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1853},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1814},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1197}]}]},{"description":"Room/bed: Ccu","code_information":[{"code":"3150040","type":"CDM"},{"code":"210","type":"RC"},{"code":"CP3150040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1194,"maximum":1867,"gross_charge":1945,"discounted_cash":1751,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1225},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1867},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1206},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1848},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1809},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1194}]}]},{"description":"Nm Imagingresting, Myo","code_information":[{"code":"4060010-TC","type":"CDM"},{"code":"341","type":"RC"},{"code":"78464","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1194,"maximum":1867,"gross_charge":1945,"discounted_cash":1751,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1225},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1867},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1206},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1848},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1809},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1194}]}]},{"description":"58805 Drainage Of Ovarian Cyst(s), Unilateral Or Bilateral; Abdominal Approach","code_information":[{"code":"3337136","type":"CDM"},{"code":"58805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1193,"maximum":1866,"gross_charge":1944,"discounted_cash":1750,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1225},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1866},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1205},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1847},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1808},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1193}]}]},{"description":"Nitroprusside 50.  Soln [Gmh]","code_information":[{"code":"4501960","type":"CDM"},{"code":"250","type":"RC"},{"code":"42998030202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1192,"maximum":1864,"gross_charge":1942,"discounted_cash":1748,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1223},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1864},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1204},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1845},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1806},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1192},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1204}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Room/bed: Acute","code_information":[{"code":"3100010","type":"CDM"},{"code":"110","type":"RC"},{"code":"CP3100010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1191,"maximum":1862,"gross_charge":1940,"discounted_cash":1746,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1222},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1862},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1843},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1804},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1191}]}]},{"description":"Ventralex Mesh Medium ( C )","code_information":[{"code":"4300773","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300773","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1190,"maximum":1860,"gross_charge":1938,"discounted_cash":1744,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1221},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1841},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1802},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1190}]}]},{"description":"58921 Treatment Of Missed Abortion, Completed Surgically, Second Trimester","code_information":[{"code":"3338030","type":"CDM"},{"code":"521","type":"RC"},{"code":"59821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1189,"maximum":1860,"gross_charge":1937,"discounted_cash":1743,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1840},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1801},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1189}]}]},{"description":"Fetal Pillow (C)","code_information":[{"code":"4302169","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302169","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1189,"maximum":1860,"gross_charge":1937,"discounted_cash":1743,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1860},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1840},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1801},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1189}]}]},{"description":"Trans-vag Tape ( C )","code_information":[{"code":"4309016","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1188,"maximum":1858,"gross_charge":1935,"discounted_cash":1742,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1219},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1858},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1838},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1800},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1188}]}]},{"description":"58673 Laparoscopy Salpingostomy .","code_information":[{"code":"CP17805908878497799","type":"CDM"},{"code":"CP17805908878497799","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1178,"maximum":1843,"gross_charge":1920,"discounted_cash":1728,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1210},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1843},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1824},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1786},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1178}]}]},{"description":"Novasure Ablation Device","code_information":[{"code":"4309015","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1137,"maximum":1778,"gross_charge":1852,"discounted_cash":1667,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1167},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1778},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1148},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1759},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1722},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1137}]}]},{"description":"59830 Treatment Of Septic Abortion, Completed Surgically","code_information":[{"code":"3338031","type":"CDM"},{"code":"59830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1130,"maximum":1767,"gross_charge":1841,"discounted_cash":1657,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1767},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1749},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1712},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1130}]}]},{"description":"2.7 Cannulated Drill Bit 310.67","code_information":[{"code":"4309958","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309958","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1129,"maximum":1766,"gross_charge":1840,"discounted_cash":1656,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1159},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1766},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1748},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1711},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1129}]}]},{"description":"Gemcitabine Hcl 1000 Mg [Gmh]","code_information":[{"code":"4505261","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002750201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1122,"maximum":1755,"gross_charge":1828,"discounted_cash":1645,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1755},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1737},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1700},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1122},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1133}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Cyclophosphamide 1,000 Mg Powder-inj [Gmh]","code_information":[{"code":"4506041","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019095601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1110,"maximum":1736,"gross_charge":1808,"discounted_cash":1627,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1736},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1718},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1681},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1110},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1121}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Nm Mugagated Blood Pool","code_information":[{"code":"4068000","type":"CDM"},{"code":"341","type":"RC"},{"code":"78472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1108,"maximum":1733,"gross_charge":1805,"discounted_cash":1625,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1733},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1715},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1679},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1108}]}]},{"description":"Cardiac Echocardiogram W/ Stress","code_information":[{"code":"4040010-TC","type":"CDM"},{"code":"943","type":"RC"},{"code":"93350","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1105,"maximum":1728,"gross_charge":1800,"discounted_cash":1620,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1728},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1710},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1674},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1105}]}]},{"description":"Nm Gastric Empty","code_information":[{"code":"4060038","type":"CDM"},{"code":"341","type":"RC"},{"code":"78264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1105,"maximum":1728,"gross_charge":1800,"discounted_cash":1620,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1728},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1710},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1674},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1105}]}]},{"description":"Ct Ltd Or Localized Fol-up","code_information":[{"code":"3760126-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"76380","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1099,"maximum":1718,"gross_charge":1790,"discounted_cash":1611,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1718},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1701},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1665},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1099}]}]},{"description":"Cmc Tightrope 1.1mm","code_information":[{"code":"4301119","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301119","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1099,"maximum":1718,"gross_charge":1790,"discounted_cash":1611,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1718},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1701},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1665},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1099}]}]},{"description":"Nm Hepatobiliary Study","code_information":[{"code":"4060066-TC","type":"CDM"},{"code":"341","type":"RC"},{"code":"78226","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1085,"maximum":1696,"gross_charge":1767,"discounted_cash":1590,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1696},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1679},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1643},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1085}]}]},{"description":"57230 Plastic Repair Of Urethrocele","code_information":[{"code":"3338003","type":"CDM"},{"code":"57230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1078,"maximum":1687,"gross_charge":1757,"discounted_cash":1581,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1687},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1089},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1669},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1634},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1078}]}]},{"description":"99291fac Ed Critical Care","code_information":[{"code":"3601206","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1074,"maximum":1680,"gross_charge":1750,"discounted_cash":1575,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1680},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1663},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1628},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1074}]}]},{"description":"Us Carotid Duplex Bil","code_information":[{"code":"4020001-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93880","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1074,"maximum":1680,"gross_charge":1750,"discounted_cash":1575,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1680},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1663},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1628},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1074}]}]},{"description":"Cataract W/astigmatism Symfony,toric,multifocal Toric, Acrysof Iq ( Sightpath )","code_information":[{"code":"4300974","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300974","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1074,"maximum":1680,"gross_charge":1750,"discounted_cash":1575,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1680},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1663},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1628},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1074}]}]},{"description":"Cataract W/ext Depth Alcon Vivity, Panoptix ( Sightpath )","code_information":[{"code":"4300987","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300987","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1074,"maximum":1680,"gross_charge":1750,"discounted_cash":1575,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1680},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1663},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1628},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1074}]}]},{"description":"Rabies Immune Globulin, Human 300 Units/ml 1 Ml Sol [Gmh]","code_information":[{"code":"4506065","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533031801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1058,"maximum":1655,"gross_charge":1724,"discounted_cash":1552,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1086},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1655},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1069},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1638},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1603},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1058},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1069}]}],"drug_information":{"unit":300,"type":"UN"}},{"description":"59070 Transabdominal Amnioninfusion Including Ultrasound Guidance","code_information":[{"code":"3338024","type":"CDM"},{"code":"521","type":"RC"},{"code":"59070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1055,"maximum":1650,"gross_charge":1719,"discounted_cash":1547,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1083},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1650},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1066},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1633},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1599},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1055}]}]},{"description":"58800 Drainage Of Ovarian Cyst(s), Unilateral Or Bilateral; Vaginal Approach","code_information":[{"code":"3337135","type":"CDM"},{"code":"58800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1047,"maximum":1637,"gross_charge":1705,"discounted_cash":1535,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1074},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1637},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1057},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1620},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1586},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1047}]}]},{"description":"Nm Liver Imaging (3d) W/vascular Flow","code_information":[{"code":"4060020","type":"CDM"},{"code":"341","type":"RC"},{"code":"78202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1043,"maximum":1632,"gross_charge":1700,"discounted_cash":1530,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1071},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1632},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Ct Renal Biopsy","code_information":[{"code":"3760134","type":"CDM"},{"code":"350","type":"RC"},{"code":"50200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1043,"maximum":1632,"gross_charge":1700,"discounted_cash":1530,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1071},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1632},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Us Le Veins Duplex Bil","code_information":[{"code":"4020060-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93970","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1043,"maximum":1632,"gross_charge":1700,"discounted_cash":1530,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1071},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1632},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Us Renal Biopsy","code_information":[{"code":"3740016","type":"CDM"},{"code":"402","type":"RC"},{"code":"50200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1043,"maximum":1632,"gross_charge":1700,"discounted_cash":1530,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1071},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1632},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Biocomposite Biceps Button Delivery System","code_information":[{"code":"4301114","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301114","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1043,"maximum":1632,"gross_charge":1700,"discounted_cash":1530,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1071},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1632},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Distal Bicep Repair Kit","code_information":[{"code":"4301147","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301147","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1043,"maximum":1632,"gross_charge":1700,"discounted_cash":1530,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1071},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1632},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1615},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1043}]}]},{"description":"Cardioversion","code_information":[{"code":"4000400","type":"CDM"},{"code":"761","type":"RC"},{"code":"92960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1037,"maximum":1622,"gross_charge":1690,"discounted_cash":1521,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1065},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1622},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1048},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1606},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1572},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1037}]}]},{"description":"Hydroxyprogesterone 250 Mg/ml Sol [Gmh]","code_information":[{"code":"4505052","type":"CDM"},{"code":"250","type":"RC"},{"code":"64011024702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1029,"maximum":1609,"gross_charge":1676,"discounted_cash":1508,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1609},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1039},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1592},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1559},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1029},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1039}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Or Lcp Recons Plate 3.5mm 12 Hole 245.121","code_information":[{"code":"4300033","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1028,"maximum":1607,"gross_charge":1674,"discounted_cash":1507,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1055},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1607},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1038},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1590},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1557},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1028}]}]},{"description":"93018 Reading Pro Fee","code_information":[{"code":"4000050","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1019,"maximum":1594,"gross_charge":1660,"discounted_cash":1494,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1046},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1594},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1029},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1577},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1544},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1019}]}]},{"description":"Cataract W/astigmatism B&l Trulign ( Sightpath )","code_information":[{"code":"4300975","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300975","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1019,"maximum":1594,"gross_charge":1660,"discounted_cash":1494,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1046},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1594},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1029},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1577},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1544},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1019}]}]},{"description":"Ct Si Joint Inj Lt","code_information":[{"code":"3760127-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"27096","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1007,"maximum":1574,"gross_charge":1640,"discounted_cash":1476,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1033},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1574},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1017},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1525},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1007}]}]},{"description":"Ct Si Joint Inj Rt","code_information":[{"code":"3760128-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"27096","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1007,"maximum":1574,"gross_charge":1640,"discounted_cash":1476,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1033},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1574},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1017},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1525},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1007}]}]},{"description":"Ct Si Joint Inj Bil","code_information":[{"code":"3760129-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"27096","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1007,"maximum":1574,"gross_charge":1640,"discounted_cash":1476,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1033},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1574},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1017},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1558},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1525},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1007}]}]},{"description":"Piperacillin-tazobactam 4 G-0.5 G Premix [Gmh]","code_information":[{"code":"4507218","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264345022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1005,"maximum":1572,"gross_charge":1638,"discounted_cash":1474,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1032},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1572},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1016},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1556},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1523},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1005},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1016}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Nm Bone Scan Multi Bone, Joint","code_information":[{"code":"4067500-TC","type":"CDM"},{"code":"341","type":"RC"},{"code":"78305","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":1005,"maximum":1572,"gross_charge":1637,"discounted_cash":1473,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1031},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1572},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1555},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1522},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1005}]}]},{"description":"Aqueous Shunt Non Valve Baerveldt ( Sightpath )","code_information":[{"code":"4300991","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300991","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":1000,"maximum":1565,"gross_charge":1630,"discounted_cash":1467,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1027},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1011},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1549},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1516},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1000}]}]},{"description":"Ventralex Mesh Small (C)","code_information":[{"code":"4300772","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300772","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":991,"maximum":1550,"gross_charge":1615,"discounted_cash":1454,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1017},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1550},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1001},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1534},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1502},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":991}]}]},{"description":"Or 3.5mm Lcp Plate 14 Hole 223.641","code_information":[{"code":"4300021","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":991,"maximum":1549,"gross_charge":1614,"discounted_cash":1453,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1017},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1549},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1001},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1533},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1501},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":991}]}]},{"description":"Or 3.5mm Lcp Plate 12 Hole 223.621","code_information":[{"code":"4300020","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":983,"maximum":1538,"gross_charge":1602,"discounted_cash":1442,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1009},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1538},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":993},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1522},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1490},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":983}]}]},{"description":"Mobile Cardiac Telemetry Event","code_information":[{"code":"4050025","type":"CDM"},{"code":"731","type":"RC"},{"code":"93229","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":982,"maximum":1536,"gross_charge":1600,"discounted_cash":1440,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1536},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":992},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1520},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1488},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":982}]}]},{"description":"Nm Hepatobiliary Imag Wo Gbef","code_information":[{"code":"4060068","type":"CDM"},{"code":"341","type":"RC"},{"code":"78226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":982,"maximum":1536,"gross_charge":1600,"discounted_cash":1440,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1536},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":992},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1520},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1488},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":982}]}]},{"description":"94002 Rt Vent Setup Charge","code_information":[{"code":"3900098","type":"CDM"},{"code":"410","type":"RC"},{"code":"94002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":982,"maximum":1536,"gross_charge":1600,"discounted_cash":1440,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1536},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":992},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1520},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1488},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":982}]}]},{"description":"Nm Kidney Flow/function W/ & W/o Pharm Intervention","code_information":[{"code":"4060031","type":"CDM"},{"code":"341","type":"RC"},{"code":"78709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":967,"maximum":1512,"gross_charge":1575,"discounted_cash":1418,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":992},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1512},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1496},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":967}]}]},{"description":"99285fac Ed Level 5room Charge","code_information":[{"code":"3601205","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":964,"maximum":1507,"gross_charge":1570,"discounted_cash":1413,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":989},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1507},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":973},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1460},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":964}]}]},{"description":"Cataract W/presbyopia Iol ( Sightpath )","code_information":[{"code":"4300926","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300926","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":964,"maximum":1507,"gross_charge":1570,"discounted_cash":1413,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":989},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1507},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":973},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1460},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":964}]}]},{"description":"Cataract W/ext Depth Symfony ( Sightpath )","code_information":[{"code":"4300988","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300988","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":964,"maximum":1507,"gross_charge":1570,"discounted_cash":1413,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":989},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1507},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":973},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1460},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":964}]}]},{"description":"Cataract W/ext Depth Synergy ( Sightpath )","code_information":[{"code":"4300989","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300989","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":964,"maximum":1507,"gross_charge":1570,"discounted_cash":1413,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":989},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1507},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":973},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1460},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":964}]}]},{"description":"59140 Surgical Treatment Of Ectopic Pregnancy; Cervical, With Evacuation","code_information":[{"code":"3338028","type":"CDM"},{"code":"59140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":964,"maximum":1507,"gross_charge":1570,"discounted_cash":1413,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":989},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1507},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":973},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1492},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1460},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":964}]}]},{"description":"27266 Cl Tx Post Hip Arth W/an Ed Charge","code_information":[{"code":"3331115","type":"CDM"},{"code":"450","type":"RC"},{"code":"27266","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":961,"maximum":1502,"gross_charge":1565,"discounted_cash":1409,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":986},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1502},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":970},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1487},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1455},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":961}]}]},{"description":"58555 Hysteroscopy, Diagnostic","code_information":[{"code":"3337129","type":"CDM"},{"code":"58555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":956,"maximum":1496,"gross_charge":1558,"discounted_cash":1402,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":982},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1496},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":966},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1480},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1449},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":956}]}]},{"description":"Tx Closed Elbow Dislocation","code_information":[{"code":"3332009","type":"CDM"},{"code":"450","type":"RC"},{"code":"24605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":956,"maximum":1495,"gross_charge":1557,"discounted_cash":1401,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":981},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1495},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":965},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1479},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1448},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":956}]}]},{"description":"27562 Closed Treatment Of Patellar Dislocation","code_information":[{"code":"3332466","type":"CDM"},{"code":"521","type":"RC"},{"code":"27562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":948,"maximum":1482,"gross_charge":1544,"discounted_cash":1390,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":973},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1482},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":957},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1467},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1436},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":948}]}]},{"description":"Power Port 8fr Chronoflex ( C )","code_information":[{"code":"4301085","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301085","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":936,"maximum":1464,"gross_charge":1525,"discounted_cash":1373,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1464},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":946},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1449},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1418},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":936}]}]},{"description":"Nm Renal W/ Vasc Flow & Function","code_information":[{"code":"4067555","type":"CDM"},{"code":"341","type":"RC"},{"code":"78707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":933,"maximum":1459,"gross_charge":1520,"discounted_cash":1368,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":958},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1459},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":942},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1444},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1414},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":933}]}]},{"description":"Or Lcp Recons Plate 3.5mm 10 Hole 245.101","code_information":[{"code":"4300032","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300032","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":928,"maximum":1452,"gross_charge":1512,"discounted_cash":1361,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":953},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1452},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":937},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1436},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1406},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":928}]}]},{"description":"Aph Plt Acda Lr Irr","code_information":[{"code":"3820275","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":921,"maximum":1440,"gross_charge":1500,"discounted_cash":1350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":945},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1425},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":921}]}]},{"description":"Aph Plt Acda Pasc Lr Psoralen-treated 1","code_information":[{"code":"3820343","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":921,"maximum":1440,"gross_charge":1500,"discounted_cash":1350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":945},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1425},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":921}]}]},{"description":"Aph Plt Acda Pasc Lr Psoralen-treated 2","code_information":[{"code":"3820344","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":921,"maximum":1440,"gross_charge":1500,"discounted_cash":1350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":945},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1425},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":921}]}]},{"description":"Ea153 Aph Plt Acda>pasc Irr Lr Bm36 1","code_information":[{"code":"3820312","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":921,"maximum":1440,"gross_charge":1500,"discounted_cash":1350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":945},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1425},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":921}]}]},{"description":"Ea155 Aph Plt Acda>pasc Irr Lr Bm36 3","code_information":[{"code":"3820314","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":921,"maximum":1440,"gross_charge":1500,"discounted_cash":1350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":945},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1425},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":921}]}]},{"description":"Nm Kidney Flow/function W/ Pharm Intervention","code_information":[{"code":"4060030","type":"CDM"},{"code":"341","type":"RC"},{"code":"78708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":921,"maximum":1440,"gross_charge":1500,"discounted_cash":1350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":945},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1425},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":921}]}]},{"description":"Us Guide Paracentesis","code_information":[{"code":"3740024","type":"CDM"},{"code":"761","type":"RC"},{"code":"49083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":921,"maximum":1440,"gross_charge":1500,"discounted_cash":1350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":945},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1425},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":921}]}]},{"description":"Proximal Tenodesis Implant (C)","code_information":[{"code":"4301069","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301069","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":911,"maximum":1426,"gross_charge":1485,"discounted_cash":1337,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":936},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1426},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1411},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1381},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":911}]}]},{"description":"Ligasure 5mm Sealer Divider","code_information":[{"code":"4300873","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300873","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":908,"maximum":1420,"gross_charge":1479,"discounted_cash":1331,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":932},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1420},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":917},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1405},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1375},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":908}]}]},{"description":"Shield Spiral 30mm (C)","code_information":[{"code":"4308113","type":"CDM"},{"code":"636","type":"RC"},{"code":"A2019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":906,"maximum":1417,"gross_charge":1476,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1417},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":915},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1402},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1373},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":906}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nm Hepatobiliary Ductal Imaging","code_information":[{"code":"4068015","type":"CDM"},{"code":"341","type":"RC"},{"code":"78223","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905,"maximum":1416,"gross_charge":1475,"discounted_cash":1328,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":929},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1416},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":915},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1401},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":905}]}]},{"description":"Onabotulinumtoxina 100 Units Pow [Gmh]","code_information":[{"code":"4506008","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023114501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":897,"maximum":1404,"gross_charge":1462,"discounted_cash":1316,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1404},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":906},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1389},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1360},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":897},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":906}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Or Lcp Recons Plate 3.5mm 8 Hole 245.081","code_information":[{"code":"4300031","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":895,"maximum":1400,"gross_charge":1458,"discounted_cash":1312,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":919},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":904},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1385},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1356},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":895}]}]},{"description":"Curosurf 120mg/1.5ml (Poractant Alfa) (Surfactant) Refrigerator [Gmh]","code_information":[{"code":"4504031","type":"CDM"},{"code":"250","type":"RC"},{"code":"10122051001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":895,"maximum":1400,"gross_charge":1458,"discounted_cash":1312,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":919},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1400},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":904},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1385},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1356},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":895},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":904}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Aqueous Shunt Valve Ahmed ( Sightpath )","code_information":[{"code":"4300990","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300990","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":878,"maximum":1373,"gross_charge":1430,"discounted_cash":1287,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":901},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1373},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":887},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1359},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1330},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":878}]}]},{"description":"Integrilin 0.75mg/ml 100ml Vial [Gmh]","code_information":[{"code":"4503581","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150021899","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":878,"maximum":1373,"gross_charge":1430,"discounted_cash":1287,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":901},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1373},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":887},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1359},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1330},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":878},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":887}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Nm Bone Imaging Multi Areas/bone And /Or Join Imaging","code_information":[{"code":"4067500","type":"CDM"},{"code":"341","type":"RC"},{"code":"78305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":872,"maximum":1363,"gross_charge":1420,"discounted_cash":1278,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":895},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1363},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":880},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1349},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1321},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":872}]}]},{"description":"Room/bed: Swing Bed","code_information":[{"code":"3100060","type":"CDM"},{"code":"110","type":"RC"},{"code":"CP3100060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":869,"maximum":1358,"gross_charge":1415,"discounted_cash":1274,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1358},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":877},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1316},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":869}]}]},{"description":"15273 Apply Skin Sub To Trunk, Arms, Legs; First 100 Sq Cm","code_information":[{"code":"3331816","type":"CDM"},{"code":"510","type":"RC"},{"code":"15273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":859,"maximum":1344,"gross_charge":1400,"discounted_cash":1260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":882},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":868},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1330},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":859}]}]},{"description":"Ct Drain Abscess Or Cyst","code_information":[{"code":"3760135","type":"CDM"},{"code":"350","type":"RC"},{"code":"49405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":859,"maximum":1344,"gross_charge":1400,"discounted_cash":1260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":882},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":868},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1330},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":859}]}]},{"description":"Us Drain Abscess Or Cyst","code_information":[{"code":"3740022","type":"CDM"},{"code":"402","type":"RC"},{"code":"49405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":859,"maximum":1344,"gross_charge":1400,"discounted_cash":1260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":882},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1344},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":868},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1330},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":859}]}]},{"description":"Or Lcp Recons Plate 3.5mm 7 Hole 245.071","code_information":[{"code":"4300030","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300030","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":858,"maximum":1342,"gross_charge":1398,"discounted_cash":1258,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":881},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1342},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":867},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1328},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1300},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":858}]}]},{"description":"Us Le Veins Duplex Lt","code_information":[{"code":"4020016-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93971","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":857,"maximum":1340,"gross_charge":1396,"discounted_cash":1256,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":879},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1326},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":857}]}]},{"description":"Us Le Veins Duplex Rt","code_information":[{"code":"4020017-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93971","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":857,"maximum":1340,"gross_charge":1396,"discounted_cash":1256,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":879},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1326},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":857}]}]},{"description":"Us Ue Veins Duplex Lt","code_information":[{"code":"4020063-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93971","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":857,"maximum":1340,"gross_charge":1396,"discounted_cash":1256,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":879},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1326},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":857}]}]},{"description":"Us Ue Veins Duplex Rt","code_information":[{"code":"4020062-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93971","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":857,"maximum":1340,"gross_charge":1396,"discounted_cash":1256,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":879},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1326},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":857}]}]},{"description":"Or Lcp T Plate 3h/7h 241.171","code_information":[{"code":"4300036","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":857,"maximum":1340,"gross_charge":1396,"discounted_cash":1256,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":879},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1326},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1298},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":857}]}]},{"description":"Ultrasound of abdomen","code_information":[{"code":"3740038-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":856,"maximum":1338,"gross_charge":1394,"discounted_cash":1255,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":878},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1338},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1324},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1296},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":856}]}]},{"description":"57220 Plastic Operation On Urethral Sphincter, Vaginal Approach (Eg, Kelly Urethral Plication)","code_information":[{"code":"3337067","type":"CDM"},{"code":"57220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":856,"maximum":1338,"gross_charge":1394,"discounted_cash":1255,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":878},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1338},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1324},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1296},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":856}]}]},{"description":"62273 Inj Epidural Blood/clot Patch","code_information":[{"code":"3331945","type":"CDM"},{"code":"361","type":"RC"},{"code":"62273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":838,"maximum":1310,"gross_charge":1365,"discounted_cash":1229,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1297},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1269},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":838}]}]},{"description":"Diagnostic exam of large bowel using an endoscope","code_information":[{"code":"CP17805909763618915","type":"CDM"},{"code":"OSP","type":"RC"},{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":838,"maximum":1310,"gross_charge":1365,"discounted_cash":1229,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":860},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1297},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1269},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":838}]}]},{"description":"C-qur Mesh 6 X 8","code_information":[{"code":"4300787","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300787","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":835,"maximum":1306,"gross_charge":1360,"discounted_cash":1224,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":857},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1306},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":843},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1292},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1265},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":835}]}]},{"description":"Tetanus Immune Globulin 250 Units Sol [Gmh]","code_information":[{"code":"4505090","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533063402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":832,"maximum":1301,"gross_charge":1355,"discounted_cash":1220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1301},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1287},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":832},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":840}]}],"drug_information":{"unit":250,"type":"UN"}},{"description":"Nm Meckel's Divert Exam Bowel Imaging","code_information":[{"code":"4060023","type":"CDM"},{"code":"341","type":"RC"},{"code":"78290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":829,"maximum":1296,"gross_charge":1350,"discounted_cash":1215,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":851},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1283},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1256},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":829}]}]},{"description":"Nm Parathyroid Imaging","code_information":[{"code":"4060032","type":"CDM"},{"code":"341","type":"RC"},{"code":"78070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":829,"maximum":1296,"gross_charge":1350,"discounted_cash":1215,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":851},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1283},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1256},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":829}]}]},{"description":"Us Le Art Doppler Mult Level Bil","code_information":[{"code":"4020003-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93925","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":829,"maximum":1296,"gross_charge":1350,"discounted_cash":1215,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":851},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1283},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1256},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":829}]}]},{"description":"Prevena Plus System","code_information":[{"code":"4302028","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":822,"maximum":1286,"gross_charge":1340,"discounted_cash":1206,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1286},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1273},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1246},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":822}]}]},{"description":"Piperacillin-tazobactam 3 G-0.375 G Premix [Gmh]","code_information":[{"code":"4507216","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264344811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":819,"maximum":1282,"gross_charge":1335,"discounted_cash":1202,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":841},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1282},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":828},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1268},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":819},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":828}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Or Lcp Recons Plate 3.5mm 6 Hole 245.061","code_information":[{"code":"4300029","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300029","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":818,"maximum":1279,"gross_charge":1332,"discounted_cash":1199,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":839},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1265},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1239},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":818}]}]},{"description":"92960 Cardioversion Elective Arrhythmia External","code_information":[{"code":"3331963","type":"CDM"},{"code":"361","type":"RC"},{"code":"92960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":817,"maximum":1278,"gross_charge":1331,"discounted_cash":1198,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":839},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":825},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1264},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":817}]}]},{"description":"23655 Ed Dislocation Of Shoulder Trtmt Require Anes Charge","code_information":[{"code":"3333091","type":"CDM"},{"code":"450","type":"RC"},{"code":"23655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":815,"maximum":1274,"gross_charge":1327,"discounted_cash":1194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":836},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1274},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":823},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1261},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1234},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":815}]}]},{"description":"Nm Pulmonary Ventilation Imaging","code_information":[{"code":"4060026","type":"CDM"},{"code":"341","type":"RC"},{"code":"78579","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":813,"maximum":1272,"gross_charge":1325,"discounted_cash":1193,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":835},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":822},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1259},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":813}]}]},{"description":"Nm Tumor Localization Multiple Areas","code_information":[{"code":"4060034","type":"CDM"},{"code":"341","type":"RC"},{"code":"78801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":813,"maximum":1272,"gross_charge":1325,"discounted_cash":1193,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":835},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":822},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1259},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1232},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":813}]}]},{"description":"22900 Exc Abdl Tum Deep < 5 Cm","code_information":[{"code":"3332406","type":"CDM"},{"code":"521","type":"RC"},{"code":"22900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":813,"maximum":1271,"gross_charge":1324,"discounted_cash":1192,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":834},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1271},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":821},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1258},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1231},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":813}]}]},{"description":"Iobp Kit","code_information":[{"code":"4302072","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302072","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":810,"maximum":1267,"gross_charge":1320,"discounted_cash":1188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":832},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1267},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1254},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1228},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":810}]}]},{"description":"23350 Injection Of Dye For Imaging Of Shoulder Joint","code_information":[{"code":"3331732","type":"CDM"},{"code":"320","type":"RC"},{"code":"23350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":807,"maximum":1262,"gross_charge":1315,"discounted_cash":1184,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":828},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1262},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":815},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1249},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":807}]}]},{"description":"27093 Injection Of Dye For Imaging Of Hip Joint","code_information":[{"code":"3331737","type":"CDM"},{"code":"320","type":"RC"},{"code":"27093","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":807,"maximum":1262,"gross_charge":1315,"discounted_cash":1184,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":828},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1262},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":815},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1249},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":807}]}]},{"description":"11047 Debridement,bone Ea Addl 20cm","code_information":[{"code":"3331889","type":"CDM"},{"code":"361","type":"RC"},{"code":"11047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805,"maximum":1260,"gross_charge":1312,"discounted_cash":1181,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":813},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1246},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1220},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":805}]}]},{"description":"15277 Apply Skin Sub To Head, Genitalia, Hands, Feet; First 100 Sq Cm","code_information":[{"code":"3331817","type":"CDM"},{"code":"510","type":"RC"},{"code":"15277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":798,"maximum":1248,"gross_charge":1300,"discounted_cash":1170,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":819},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":806},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1235},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1209},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":798}]}]},{"description":"Novachor 5 Sq Cm","code_information":[{"code":"4308109","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":798,"maximum":1248,"gross_charge":1300,"discounted_cash":1170,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":819},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":806},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1235},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1209},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":798}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Azacitidine 100. Mg Powder-inj [Gmh]","code_information":[{"code":"4501099","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781325394","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":789,"maximum":1234,"gross_charge":1285,"discounted_cash":1157,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":810},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":797},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1221},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":797}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Bio Glue 2ml","code_information":[{"code":"4301748","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301748","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":784,"maximum":1227,"gross_charge":1278,"discounted_cash":1150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":805},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1227},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":792},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1214},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1189},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":784}]}]},{"description":"Nm Acute Gi Blood Loss Imaging","code_information":[{"code":"4060035","type":"CDM"},{"code":"341","type":"RC"},{"code":"78278","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":783,"maximum":1224,"gross_charge":1275,"discounted_cash":1148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":803},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1211},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":783}]}]},{"description":"Remdesivir 100 Mg Pow","code_information":[{"code":"4507003","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":778,"maximum":1217,"gross_charge":1268,"discounted_cash":1141,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":799},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1217},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1205},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1179},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":786}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Or 3.5mm Lcp Plate 7 Hole 223.571","code_information":[{"code":"4309111","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309111","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":777,"maximum":1215,"gross_charge":1266,"discounted_cash":1139,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1215},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":785},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1203},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":777}]}]},{"description":"Amifostine 500 Mg Pow [Gmh]","code_information":[{"code":"CP17805909631288674","type":"CDM"},{"code":"250","type":"RC"},{"code":"55390030803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":767,"maximum":1200,"gross_charge":1250,"discounted_cash":1125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":788},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1200},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":775},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1188},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":767},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":775}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nm Bone Limited Area","code_information":[{"code":"4067525-TC","type":"CDM"},{"code":"341","type":"RC"},{"code":"78300","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":765,"maximum":1197,"gross_charge":1247,"discounted_cash":1122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":773},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1185},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":765}]}]},{"description":"25605 Treat Fracture Radius/ulna","code_information":[{"code":"3332410","type":"CDM"},{"code":"521","type":"RC"},{"code":"25605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":765,"maximum":1197,"gross_charge":1247,"discounted_cash":1122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":773},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1185},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1160},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":765}]}]},{"description":"Ventralex Mesh Large","code_information":[{"code":"4300774","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300774","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":761,"maximum":1190,"gross_charge":1240,"discounted_cash":1116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":781},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":769},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1178},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":761}]}]},{"description":"36430 Blood Adminstration","code_information":[{"code":"625579","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":756,"maximum":1183,"gross_charge":1232,"discounted_cash":1109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":776},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":764},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1170},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1146},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":756}]}]},{"description":"32551 Tube Thoracostomy Includes Water Seal","code_information":[{"code":"3331939","type":"CDM"},{"code":"361","type":"RC"},{"code":"32551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":742,"maximum":1161,"gross_charge":1209,"discounted_cash":1088,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":762},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":750},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1149},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1124},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":742}]}]},{"description":"Nm Liver And Spleen Imaging W/vascular Flow","code_information":[{"code":"4060022","type":"CDM"},{"code":"341","type":"RC"},{"code":"78216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":737,"maximum":1152,"gross_charge":1200,"discounted_cash":1080,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":737}]}]},{"description":"Us Abdomen Comp W/ Doppler","code_information":[{"code":"4020068-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93975","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":737,"maximum":1152,"gross_charge":1200,"discounted_cash":1080,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":737}]}]},{"description":"Cataract W/astigmatism J&j Eyhance Toric ( Sightpath )","code_information":[{"code":"4300977","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300977","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":737,"maximum":1152,"gross_charge":1200,"discounted_cash":1080,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":737}]}]},{"description":"Shield Adhesive 15mm","code_information":[{"code":"4308115","type":"CDM"},{"code":"636","type":"RC"},{"code":"A2019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":737,"maximum":1152,"gross_charge":1200,"discounted_cash":1080,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":737}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Room/bed: Hospice","code_information":[{"code":"3100075","type":"CDM"},{"code":"656","type":"RC"},{"code":"CP3100075","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":737,"maximum":1152,"gross_charge":1200,"discounted_cash":1080,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":756},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":737}]}]},{"description":"56440 Marsupialization Of Bartholin's Gland Cyst","code_information":[{"code":"3333204","type":"CDM"},{"code":"56440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":732,"maximum":1145,"gross_charge":1193,"discounted_cash":1074,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":752},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1145},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":740},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1109},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":732}]}]},{"description":"59350 Hysterorrhaphy Of Ruptured Uterus","code_information":[{"code":"3337147","type":"CDM"},{"code":"59350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":731,"maximum":1143,"gross_charge":1191,"discounted_cash":1072,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":750},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1143},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":738},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1131},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":731}]}]},{"description":"11043 Debridement,muscle,dermis,sq 20 Sq Cm < Tech Fee","code_information":[{"code":"3331886","type":"CDM"},{"code":"361","type":"RC"},{"code":"11043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":729,"maximum":1140,"gross_charge":1188,"discounted_cash":1069,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":748},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":737},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1129},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1105},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":729}]}]},{"description":"Immune Globulin Intravenous And Subcutaneous 10% 5 Gm Sol Gamunex-c [Gmh]","code_information":[{"code":"4507075","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":724,"maximum":1133,"gross_charge":1180,"discounted_cash":1062,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":743},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":732},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1121},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1097},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":724},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":732}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"C-qur V Patch Mesh 3.2 X 3.2","code_information":[{"code":"4300782","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300782","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":723,"maximum":1131,"gross_charge":1178,"discounted_cash":1060,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1119},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1096},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":723}]}]},{"description":"Oval Button","code_information":[{"code":"4306019","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":721,"maximum":1128,"gross_charge":1175,"discounted_cash":1058,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":740},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1128},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":729},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1116},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1093},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":721}]}]},{"description":"Hyaluronan 30 Mg/2 Ml Sol","code_information":[{"code":"4505026","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676036001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":716,"maximum":1120,"gross_charge":1167,"discounted_cash":1050,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":724},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1085},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":724}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"19020 Incision Of Breast Lesion.","code_information":[{"code":"3332403","type":"CDM"},{"code":"521","type":"RC"},{"code":"19020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":711,"maximum":1113,"gross_charge":1159,"discounted_cash":1043,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1101},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1078},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":711}]}]},{"description":"21930 Exc Back Les Sc < 3 Cm","code_information":[{"code":"3332405","type":"CDM"},{"code":"521","type":"RC"},{"code":"21930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":711,"maximum":1113,"gross_charge":1159,"discounted_cash":1043,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1101},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1078},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":711}]}]},{"description":"Ketorolac-phenylephrine Ophthalmic 0.3%-1% Sol [Gmh]","code_information":[{"code":"4505059","type":"CDM"},{"code":"250","type":"RC"},{"code":"62225060004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":708,"maximum":1107,"gross_charge":1153,"discounted_cash":1038,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":726},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1095},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1072},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":715}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Or Lcp Recons Plate 3.5mm 5 Hole 245.051","code_information":[{"code":"4300028","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":707,"maximum":1106,"gross_charge":1152,"discounted_cash":1037,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":726},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":714},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1094},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1071},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":707}]}]},{"description":"Nm Tumor Localization Limited Area","code_information":[{"code":"4060033","type":"CDM"},{"code":"341","type":"RC"},{"code":"78800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":706,"maximum":1104,"gross_charge":1150,"discounted_cash":1035,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1093},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1070},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":706}]}]},{"description":"94003 Rt Vent Daily Charge","code_information":[{"code":"3900099","type":"CDM"},{"code":"410","type":"RC"},{"code":"94003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":706,"maximum":1104,"gross_charge":1150,"discounted_cash":1035,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1093},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1070},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":706}]}]},{"description":"Pleurx Pleural Cath Kit","code_information":[{"code":"4303052","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303052","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":706,"maximum":1104,"gross_charge":1150,"discounted_cash":1035,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1093},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1070},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":706}]}]},{"description":"Conjugated Estrogens Topical 0.625 Mg/g Cream [Gmh]","code_information":[{"code":"4507233","type":"CDM"},{"code":"250","type":"RC"},{"code":"00046087221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":697,"maximum":1091,"gross_charge":1136,"discounted_cash":1022,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1091},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":704},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1079},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":697},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":704}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Us Ue Art Duplex Bil","code_information":[{"code":"3740047-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93930","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":691,"maximum":1080,"gross_charge":1125,"discounted_cash":1013,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":709},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1080},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1069},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1046},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":691}]}]},{"description":"Or Lcp T Plate 4h/6h  241.161","code_information":[{"code":"4300038","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":684,"maximum":1069,"gross_charge":1114,"discounted_cash":1003,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1069},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1058},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":684}]}]},{"description":"Tbo-filgrastim 300 Mcg/0.5 Ml Sol [Gmh]","code_information":[{"code":"4507094","type":"CDM"},{"code":"250","type":"RC"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":681,"maximum":1066,"gross_charge":1110,"discounted_cash":999,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":699},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1066},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":688},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1055},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1032},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":681},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":688}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"22902 Exc Abd Les Sc < 3 Cm","code_information":[{"code":"3332407","type":"CDM"},{"code":"521","type":"RC"},{"code":"22902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":677,"maximum":1059,"gross_charge":1103,"discounted_cash":993,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":695},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1059},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1048},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1026},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":677}]}]},{"description":"26160 Remove Tendon Sheath Lesion","code_information":[{"code":"3332412","type":"CDM"},{"code":"521","type":"RC"},{"code":"26160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":677,"maximum":1059,"gross_charge":1103,"discounted_cash":993,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":695},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1059},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1048},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1026},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":677}]}]},{"description":"93979tc Abdominal Aorta, Limited","code_information":[{"code":"4020020-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93979","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":675,"maximum":1056,"gross_charge":1100,"discounted_cash":990,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":675}]}]},{"description":"93979tc Abd Vessels Duplex Limit","code_information":[{"code":"4020064-TC","type":"CDM"},{"code":"921","type":"RC"},{"code":"93979","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":675,"maximum":1056,"gross_charge":1100,"discounted_cash":990,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":675}]}]},{"description":"Nm Perfusion Lung Image/particulate","code_information":[{"code":"4060027","type":"CDM"},{"code":"341","type":"RC"},{"code":"78580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":675,"maximum":1056,"gross_charge":1100,"discounted_cash":990,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":675}]}]},{"description":"Xr Bone Survey Comp","code_information":[{"code":"3700105-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":675,"maximum":1056,"gross_charge":1100,"discounted_cash":990,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":675}]}]},{"description":"Cataract W/astigmatism Alcon, B&l, J&j  Toric ( Sightpath )","code_information":[{"code":"4300976","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300976","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":675,"maximum":1056,"gross_charge":1100,"discounted_cash":990,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":675}]}]},{"description":"Kahook Blade Genioprism ( Sightpath )","code_information":[{"code":"4300947","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300947","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":675,"maximum":1056,"gross_charge":1100,"discounted_cash":990,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":675}]}]},{"description":"Ligasure Impact ( C )","code_information":[{"code":"4300871","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300871","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":675,"maximum":1056,"gross_charge":1100,"discounted_cash":990,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1056},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":675}]}]},{"description":"Phentolamine 5 Mg Pow [Gmh]","code_information":[{"code":"4507058","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143956401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":669,"maximum":1046,"gross_charge":1090,"discounted_cash":981,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":687},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1046},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1014},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":669},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":676}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Daptomycin Rf 500 Mg Pow [Gmh]","code_information":[{"code":"4500167","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919001201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":668,"maximum":1045,"gross_charge":1089,"discounted_cash":980,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":686},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1035},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1013},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Slf-punch Swivelock 4.75mm X 24.5mm","code_information":[{"code":"4302056","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302056","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":668,"maximum":1045,"gross_charge":1089,"discounted_cash":980,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":686},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1045},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1035},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1013},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":668}]}]},{"description":"Us Ue Art Duplex Lt","code_information":[{"code":"4020021-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93931","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":667,"maximum":1044,"gross_charge":1087,"discounted_cash":978,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1044},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1033},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1011},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":667}]}]},{"description":"Us Ue Art Duplex Rt","code_information":[{"code":"4020022-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93931","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":667,"maximum":1044,"gross_charge":1087,"discounted_cash":978,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":685},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1044},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1033},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1011},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":667}]}]},{"description":"59898 Unlisted Laparoscopy Procedure, Maternity Care And Delivery","code_information":[{"code":"3338033","type":"CDM"},{"code":"59898","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":662,"maximum":1036,"gross_charge":1079,"discounted_cash":971,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1036},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":669},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1025},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1003},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":662}]}]},{"description":"Ligasure L-hook","code_information":[{"code":"4300879","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300879","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":660,"maximum":1033,"gross_charge":1076,"discounted_cash":968,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":678},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1033},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":667},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1022},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1001},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":660}]}]},{"description":"Iovera Smart Tip 90mm","code_information":[{"code":"4309136","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309136","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":660,"maximum":1032,"gross_charge":1075,"discounted_cash":968,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":677},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1032},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":667},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1021},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1000},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":660}]}]},{"description":"Ligasure Impact Handpiece","code_information":[{"code":"4300295","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300295","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":657,"maximum":1027,"gross_charge":1070,"discounted_cash":963,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1027},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":663},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1017},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":995},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":657}]}]},{"description":"Right Angle Needle","code_information":[{"code":"4306018","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":656,"maximum":1025,"gross_charge":1068,"discounted_cash":961,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":673},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1025},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1015},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":993},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":656}]}]},{"description":"Resection Loop Large","code_information":[{"code":"4306017","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306017","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":654,"maximum":1023,"gross_charge":1066,"discounted_cash":959,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1023},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":661},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1013},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":991},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":654}]}]},{"description":"Balloon Dissector","code_information":[{"code":"4300241","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300241","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":651,"maximum":1019,"gross_charge":1061,"discounted_cash":955,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1019},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":658},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":987},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":651}]}]},{"description":"Nm Bone Imaging Limited Areas/bone And/or Joint Imaging","code_information":[{"code":"4060025","type":"CDM"},{"code":"341","type":"RC"},{"code":"78300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":644,"maximum":1008,"gross_charge":1050,"discounted_cash":945,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":644}]}]},{"description":"Suboxone Charge  8+ Hours","code_information":[{"code":"3331678","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":644,"maximum":1008,"gross_charge":1050,"discounted_cash":945,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":644}]}]},{"description":"Nm Tc99 Sestamibi (2 Doses)","code_information":[{"code":"4060054","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":644,"maximum":1008,"gross_charge":1050,"discounted_cash":945,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":644}]}]},{"description":"Us Le Art Duplex Lt","code_information":[{"code":"4020011-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93926","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":644,"maximum":1008,"gross_charge":1050,"discounted_cash":945,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":644}]}]},{"description":"Us Le Art Duplex Rt","code_information":[{"code":"4020013-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93926","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":644,"maximum":1008,"gross_charge":1050,"discounted_cash":945,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":644}]}]},{"description":"Power Port 8 Fr","code_information":[{"code":"4301084","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301084","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":644,"maximum":1008,"gross_charge":1050,"discounted_cash":945,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1008},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":644}]}]},{"description":"27530 Treat Knee Fracture.","code_information":[{"code":"3332458","type":"CDM"},{"code":"521","type":"RC"},{"code":"27530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":643,"maximum":1006,"gross_charge":1048,"discounted_cash":943,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1006},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":650},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":996},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":975},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":643}]}]},{"description":"24075 Exc Tumor Soft Tiss Upper Arm/elbow Subq <3cm","code_information":[{"code":"3331738","type":"CDM"},{"code":"521","type":"RC"},{"code":"24075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":640,"maximum":1001,"gross_charge":1043,"discounted_cash":939,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":657},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1001},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":647},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":991},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":970},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":640}]}]},{"description":"Procainamide 100 Mg/ml 10ml  Sol [Gmh]","code_information":[{"code":"4507092","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329339905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":638,"maximum":998,"gross_charge":1040,"discounted_cash":936,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":655},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":998},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":645},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":988},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":967},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":638},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":645}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Piperacillin-tazobactam 2 G-0.25 G Premix [Gmh]","code_information":[{"code":"4507217","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264344611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":634,"maximum":992,"gross_charge":1033,"discounted_cash":930,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":992},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":981},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":634},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":640}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"59001 Therapeutic Amniotic Fluid Reduction","code_information":[{"code":"3338019","type":"CDM"},{"code":"521","type":"RC"},{"code":"59001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":633,"maximum":991,"gross_charge":1032,"discounted_cash":929,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":650},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":991},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":980},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":633}]}]},{"description":"49082 Paracentesis Dx/ther W/o Imaging Guidance","code_information":[{"code":"3331942","type":"CDM"},{"code":"361","type":"RC"},{"code":"49082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":628,"maximum":982,"gross_charge":1023,"discounted_cash":921,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":982},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":634},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":972},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":951},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":628}]}]},{"description":"Duragen Plus 1x3","code_information":[{"code":"4302155","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302155","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":625,"maximum":977,"gross_charge":1018,"discounted_cash":916,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":967},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":625}]}]},{"description":"13151 Repair Complex Eyelid/nose/ear/lip 1.1-2.5 Cm","code_information":[{"code":"3331729","type":"CDM"},{"code":"521","type":"RC"},{"code":"13151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625,"maximum":977,"gross_charge":1018,"discounted_cash":916,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":977},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":967},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":625}]}]},{"description":"23665 Closed Tx Of Shoulder Dislocation, W Fracture Of Greater Humeral Tuberosity, W Manipulation","code_information":[{"code":"3331750","type":"CDM"},{"code":"521","type":"RC"},{"code":"23665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":624,"maximum":975,"gross_charge":1016,"discounted_cash":914,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":975},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":965},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":945},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":624}]}]},{"description":"Plasma Roller Ball","code_information":[{"code":"4306033","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":623,"maximum":974,"gross_charge":1015,"discounted_cash":914,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":639},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":964},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":944},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":623}]}]},{"description":"Resection Loop Mediuim","code_information":[{"code":"4306020","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":623,"maximum":974,"gross_charge":1015,"discounted_cash":914,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":639},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":974},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":964},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":944},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":623}]}]},{"description":"Us Soft Tissue Neck","code_information":[{"code":"3740034-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":622,"maximum":972,"gross_charge":1013,"discounted_cash":912,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":638},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":972},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":628},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":962},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":942},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":622}]}]},{"description":"27750 Cltx Tibial Shaft Fx W/o Manipulation","code_information":[{"code":"3332453","type":"CDM"},{"code":"521","type":"RC"},{"code":"27750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":619,"maximum":969,"gross_charge":1009,"discounted_cash":908,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":969},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":626},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":959},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":619}]}]},{"description":"Affinity 2.5 X 2.5","code_information":[{"code":"4308110","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":617,"maximum":965,"gross_charge":1005,"discounted_cash":905,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":965},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":955},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":935},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":617}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"92950 Anesth Cardiopulmonary Resuscitation","code_information":[{"code":"3500170","type":"CDM"},{"code":"450","type":"RC"},{"code":"92950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":614,"maximum":961,"gross_charge":1001,"discounted_cash":901,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":631},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":621},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":951},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":931},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":614}]}]},{"description":"Nm Liver And Spleen Imaging Static Only","code_information":[{"code":"4060021","type":"CDM"},{"code":"341","type":"RC"},{"code":"78215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":614,"maximum":960,"gross_charge":1000,"discounted_cash":900,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":620},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":950},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":614}]}]},{"description":"38220 Bone Marrow Aspiration","code_information":[{"code":"3331990","type":"CDM"},{"code":"361","type":"RC"},{"code":"38220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":614,"maximum":960,"gross_charge":1000,"discounted_cash":900,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":620},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":950},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":614}]}]},{"description":"Us Echo 2d Ltd","code_information":[{"code":"4040000-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93308","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":614,"maximum":960,"gross_charge":1000,"discounted_cash":900,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":960},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":620},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":950},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":930},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":614}]}]},{"description":"Capio Slim Hook ( C )","code_information":[{"code":"4301189","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301189","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":612,"maximum":957,"gross_charge":997,"discounted_cash":897,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":628},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":957},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":947},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":927},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":612}]}]},{"description":"57135 Excision Of Vaginal Cyst Of Tumor","code_information":[{"code":"3337058","type":"CDM"},{"code":"57135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":608,"maximum":951,"gross_charge":991,"discounted_cash":892,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":951},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":614},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":941},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":922},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":608}]}]},{"description":"Fiberstitch Implant","code_information":[{"code":"4301120","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301120","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":608,"maximum":950,"gross_charge":990,"discounted_cash":891,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":950},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":614},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":941},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":608}]}]},{"description":"Retrograde Ligament Knife","code_information":[{"code":"4300340","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300340","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":608,"maximum":950,"gross_charge":990,"discounted_cash":891,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":950},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":614},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":941},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":921},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":608}]}]},{"description":"Prevena Peel And Place (C)","code_information":[{"code":"4302078","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302078","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":606,"maximum":948,"gross_charge":988,"discounted_cash":889,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":948},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":613},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":939},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":919},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":606}]}]},{"description":"Bupivacaine Liposome 1.3% 20ml (13.3 Mg/ml) Sus  [Gmh]","code_information":[{"code":"4505014","type":"CDM"},{"code":"250","type":"RC"},{"code":"65250026609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":600,"maximum":938,"gross_charge":977,"discounted_cash":879,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":938},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":928},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":909},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":606}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Or 3.5mm Lcp Plate 10 Hole 223.601","code_information":[{"code":"4300019","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":599,"maximum":937,"gross_charge":976,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":615},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":937},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":927},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":908},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":599}]}]},{"description":"99284fac Ed Level 4 Room Charge","code_information":[{"code":"3601204","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":598,"maximum":936,"gross_charge":975,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":614},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":936},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":926},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":907},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":598}]}]},{"description":"93226 Holter Monitor 48hour Charge Gbmh","code_information":[{"code":"4050000","type":"CDM"},{"code":"731","type":"RC"},{"code":"93226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":598,"maximum":936,"gross_charge":975,"discounted_cash":878,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":614},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":936},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":926},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":907},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":598}]}]},{"description":"Tubular Plate 8 Hole Lcp 241.381","code_information":[{"code":"4300013","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4300013","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":595,"maximum":931,"gross_charge":970,"discounted_cash":873,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":611},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":931},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":601},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":922},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":902},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":595}]}]},{"description":"3.0 Dbl Load Suturetape S-tak","code_information":[{"code":"4301176","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301176","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":583,"maximum":912,"gross_charge":950,"discounted_cash":855,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":912},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":589},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":903},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":583}]}]},{"description":"Cygnus Dual Amniotic Allograft 2x3cm","code_information":[{"code":"4308114","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":583,"maximum":912,"gross_charge":950,"discounted_cash":855,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":912},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":589},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":903},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":583}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"62270 Spinal Puncture Lumbar Diagnostic","code_information":[{"code":"3331944","type":"CDM"},{"code":"361","type":"RC"},{"code":"62270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":581,"maximum":908,"gross_charge":946,"discounted_cash":851,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":596},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":908},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":587},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":899},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":880},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":581}]}]},{"description":"Or 3.5mm Lcp Plate 9 Hole 223.591","code_information":[{"code":"4300018","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":581,"maximum":908,"gross_charge":946,"discounted_cash":851,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":596},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":908},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":587},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":899},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":880},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":581}]}]},{"description":"Room/bed: Nursery","code_information":[{"code":"3200080","type":"CDM"},{"code":"170","type":"RC"},{"code":"CP3200080","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":580,"maximum":907,"gross_charge":945,"discounted_cash":851,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":595},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":907},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":898},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":879},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":580}]}]},{"description":"Swivelock W/ Fibertape","code_information":[{"code":"4302070","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302070","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":577,"maximum":902,"gross_charge":940,"discounted_cash":846,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":902},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":893},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":874},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":577}]}]},{"description":"56515 Destruction Of Lesion (S)l Vulva Extensive","code_information":[{"code":"3337003","type":"CDM"},{"code":"56515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":576,"maximum":900,"gross_charge":938,"discounted_cash":844,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":582},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":576}]}]},{"description":"11644 Excision, Malign Lesion; Face, Ears, Eyelids, Nose, Lips (3.1-4cm)","code_information":[{"code":"3332455","type":"CDM"},{"code":"521","type":"RC"},{"code":"11644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":576,"maximum":900,"gross_charge":938,"discounted_cash":844,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":582},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":576}]}]},{"description":"24500 Closed Treatment Of Humeral Shaft Fracture; W/o Manipulation","code_information":[{"code":"3332470","type":"CDM"},{"code":"521","type":"RC"},{"code":"24500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":576,"maximum":900,"gross_charge":938,"discounted_cash":844,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":582},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":576}]}]},{"description":"26775 Treat Finger Dislocation.","code_information":[{"code":"3332414","type":"CDM"},{"code":"521","type":"RC"},{"code":"26775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":576,"maximum":900,"gross_charge":938,"discounted_cash":844,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":591},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":582},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":891},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":576}]}]},{"description":"Surestrap Staple Device ( 25 ) ( C )","code_information":[{"code":"4301733","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301733","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":575,"maximum":899,"gross_charge":936,"discounted_cash":842,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":899},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":580},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":889},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":870},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":575}]}]},{"description":"24576 Closed Treatment Of Humeral Condylar Fracture, Medial Or Lateral; Without Manipulation","code_information":[{"code":"3331878","type":"CDM"},{"code":"521","type":"RC"},{"code":"24576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":574,"maximum":898,"gross_charge":935,"discounted_cash":842,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":589},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":898},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":580},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":888},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":870},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":574}]}]},{"description":"13152 Repair Complex Eyelid/nose/ear/lip 2.6-7.5 Cm","code_information":[{"code":"3331905","type":"CDM"},{"code":"361","type":"RC"},{"code":"13152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":573,"maximum":897,"gross_charge":934,"discounted_cash":841,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":897},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":579},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":887},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":869},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":573}]}]},{"description":"Fibertak Anchor","code_information":[{"code":"4301136","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301136","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":571,"maximum":893,"gross_charge":930,"discounted_cash":837,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":893},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":865},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":571}]}]},{"description":"Blade Precision Falcon","code_information":[{"code":"4301182","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301182","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":563,"maximum":881,"gross_charge":918,"discounted_cash":826,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":881},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":569},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":872},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":563}]}]},{"description":"Nirsevimab-alip (Cvx 307) (Beyfortus) Vaccine 100 Mgcharge","code_information":[{"code":"3332374","type":"CDM"},{"code":"636","type":"RC"},{"code":"90381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":562,"maximum":878,"gross_charge":915,"discounted_cash":824,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":878},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":869},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":851},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":562}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nirsevimab-alip (Cvx 306) (Beyfortus) Vaccine 50 Mg Charge","code_information":[{"code":"3332373","type":"CDM"},{"code":"636","type":"RC"},{"code":"90380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":562,"maximum":878,"gross_charge":915,"discounted_cash":824,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":878},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":869},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":851},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":562}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"C-qur V Patch Mesh 2.5 X 2.5","code_information":[{"code":"4300784","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300784","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":560,"maximum":876,"gross_charge":912,"discounted_cash":821,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":575},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":876},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":866},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":848},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":560}]}]},{"description":"Or 3.5mm Lcp Plate 8 Hole 223.581","code_information":[{"code":"4300017","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300017","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":559,"maximum":874,"gross_charge":910,"discounted_cash":819,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":573},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":874},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":865},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":559}]}]},{"description":"Tubular Plate Lcp 7 Hole 241.371","code_information":[{"code":"4300014","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4300014","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":559,"maximum":874,"gross_charge":910,"discounted_cash":819,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":573},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":874},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":865},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":559}]}]},{"description":"12020 Tx Superficial Wound Dehiscence Simple Closure","code_information":[{"code":"3331896","type":"CDM"},{"code":"361","type":"RC"},{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":556,"maximum":870,"gross_charge":906,"discounted_cash":815,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":571},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":870},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":861},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":843},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":556}]}]},{"description":"Us Retroperitoneal Comp","code_information":[{"code":"3740045-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":552,"maximum":864,"gross_charge":900,"discounted_cash":810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":552}]}]},{"description":"94660 Rt Bipap Setup/initital Day Charge","code_information":[{"code":"3900096","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":552,"maximum":864,"gross_charge":900,"discounted_cash":810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":552}]}]},{"description":"94660 Rt Bipap Subsequent Charge","code_information":[{"code":"3900097","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":552,"maximum":864,"gross_charge":900,"discounted_cash":810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":552}]}]},{"description":"94660 Rt Cpap Initial Charge","code_information":[{"code":"3900100","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":552,"maximum":864,"gross_charge":900,"discounted_cash":810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":552}]}]},{"description":"94660 Rt Cpap Subsequent Charge","code_information":[{"code":"3900101","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":552,"maximum":864,"gross_charge":900,"discounted_cash":810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":552}]}]},{"description":"Affinity 1.5x1.5","code_information":[{"code":"4308116","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":552,"maximum":864,"gross_charge":900,"discounted_cash":810,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":552}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Oxaliplatin 5 Mg/ml 20 Ml Sol [Gmh]","code_information":[{"code":"4505020","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729033205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":552,"maximum":863,"gross_charge":899,"discounted_cash":809,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":863},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":557},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":854},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":836},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":557}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tbo-filgrastim 480 Mcg/0.8 Ml Sol [Gmh]","code_information":[{"code":"4507040","type":"CDM"},{"code":"250","type":"RC"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":548,"maximum":856,"gross_charge":892,"discounted_cash":803,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":856},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":553},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":847},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":830},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":548},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":553}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"13100 Repair Complex Trunk 1.1-2.5 Cm","code_information":[{"code":"3331900","type":"CDM"},{"code":"361","type":"RC"},{"code":"13100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":547,"maximum":855,"gross_charge":891,"discounted_cash":802,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":829},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":547}]}]},{"description":"Rabies Vaccine, Purified Chick Embryo Cell 2.5 Units Pow [Gmh]","code_information":[{"code":"4506023","type":"CDM"},{"code":"250","type":"RC"},{"code":"50632001001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":544,"maximum":851,"gross_charge":886,"discounted_cash":797,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":851},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":549},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":842},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":824},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":549}]}],"drug_information":{"unit":25,"type":"UN"}},{"description":"26605 Closed Treatment Of Metacarpal Fracture, Single; With Manipulation, Each Bone.","code_information":[{"code":"3331691","type":"CDM"},{"code":"521","type":"RC"},{"code":"26605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":541,"maximum":847,"gross_charge":882,"discounted_cash":794,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":847},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":820},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":541}]}]},{"description":"24600 Treatment Of Closed Elbow Dislocation; Without Anesthesia.","code_information":[{"code":"3331759","type":"CDM"},{"code":"521","type":"RC"},{"code":"24600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":541,"maximum":846,"gross_charge":881,"discounted_cash":793,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":555},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":846},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":837},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":819},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":541}]}]},{"description":"External Neurostimulator (C)","code_information":[{"code":"4301931","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301931","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":540,"maximum":845,"gross_charge":880,"discounted_cash":792,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":845},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":836},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":540}]}]},{"description":"26725 Closed Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger Or Thumb","code_information":[{"code":"3331725","type":"CDM"},{"code":"521","type":"RC"},{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":540,"maximum":845,"gross_charge":880,"discounted_cash":792,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":554},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":845},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":836},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":818},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":540}]}]},{"description":"57000 Colpotomy; With Exploration","code_information":[{"code":"3337020","type":"CDM"},{"code":"57000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":538,"maximum":841,"gross_charge":876,"discounted_cash":788,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":841},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":832},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":815},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":538}]}]},{"description":"Us Bladder","code_information":[{"code":"CP17805908877517164-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":537,"maximum":840,"gross_charge":875,"discounted_cash":788,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":814},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":537}]}]},{"description":"25600 Closed Tx Of Distal Radius Fracture Including Casting","code_information":[{"code":"3331207","type":"CDM"},{"code":"521","type":"RC"},{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":537,"maximum":840,"gross_charge":875,"discounted_cash":788,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":840},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":831},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":814},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":537}]}]},{"description":"Carboprost 250 Mcg/ml 1 Ml  Inj Sol [Gmh]","code_information":[{"code":"4501219","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009085608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":535,"maximum":836,"gross_charge":871,"discounted_cash":784,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":549},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":836},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":827},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":810},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Echelon Stapler","code_information":[{"code":"4301621","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301621","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":533,"maximum":833,"gross_charge":868,"discounted_cash":781,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":833},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":825},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":533}]}]},{"description":"Or Lcp T Plate 4h/4h 241.141","code_information":[{"code":"4300037","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":533,"maximum":833,"gross_charge":868,"discounted_cash":781,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":833},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":825},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":533}]}]},{"description":"93923tc Arterial Segmental, Lower","code_information":[{"code":"4020005-TC","type":"CDM"},{"code":"929","type":"RC"},{"code":"93923","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":528,"maximum":826,"gross_charge":860,"discounted_cash":774,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":533},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":817},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":528}]}]},{"description":"93923tc Arterial Segmental, Upper","code_information":[{"code":"4020010-TC","type":"CDM"},{"code":"929","type":"RC"},{"code":"93923","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":528,"maximum":826,"gross_charge":860,"discounted_cash":774,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":826},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":533},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":817},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":528}]}]},{"description":"23600 Treat Humerus Fracture","code_information":[{"code":"3332408","type":"CDM"},{"code":"521","type":"RC"},{"code":"23600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":525,"maximum":821,"gross_charge":855,"discounted_cash":770,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":539},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":821},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":812},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":795},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":525}]}]},{"description":"Us Kidney Transplant Lt","code_information":[{"code":"3740028-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76776","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":522,"maximum":816,"gross_charge":850,"discounted_cash":765,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":536},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":816},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":522}]}]},{"description":"27760 Closed Treatment Of Medial Malleolus Fracture","code_information":[{"code":"3331700","type":"CDM"},{"code":"521","type":"RC"},{"code":"27760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":521,"maximum":815,"gross_charge":849,"discounted_cash":764,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":815},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":807},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":790},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":521}]}]},{"description":"Family psychotherapy, including patient, 50 min","code_information":[{"code":"3331324","type":"CDM"},{"code":"916","type":"RC"},{"code":"90847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":519,"maximum":811,"gross_charge":845,"discounted_cash":761,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":519}]}]},{"description":"27824 Treat Lower Leg Fracture.","code_information":[{"code":"3332415","type":"CDM"},{"code":"521","type":"RC"},{"code":"27824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":519,"maximum":811,"gross_charge":845,"discounted_cash":761,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":811},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":803},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":519}]}]},{"description":"Or Lcp T Plate 3h/3h 241.131","code_information":[{"code":"4300046","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300046","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":517,"maximum":808,"gross_charge":842,"discounted_cash":758,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":808},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":517}]}]},{"description":"4.0 Cannulated Sht Thd 50mm 207.650","code_information":[{"code":"4309956","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309956","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":516,"maximum":806,"gross_charge":840,"discounted_cash":756,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":806},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":781},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":516}]}]},{"description":"4.0 Cannulated Sht Thd 22mm 207.622","code_information":[{"code":"4309953","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309953","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":516,"maximum":806,"gross_charge":840,"discounted_cash":756,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":806},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":781},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":516}]}]},{"description":"4.0 Cannulated Sht Thd 40mm 207.640","code_information":[{"code":"4309954","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309954","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":516,"maximum":806,"gross_charge":840,"discounted_cash":756,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":806},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":781},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":516}]}]},{"description":"4.0 Cannulated Sht Thd 46mm 207.646","code_information":[{"code":"4309955","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309955","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":516,"maximum":806,"gross_charge":840,"discounted_cash":756,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":806},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":781},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":516}]}]},{"description":"11042 Debridement Subcutaneous Tissue 20 Sq Cm/< Techfee","code_information":[{"code":"3331885","type":"CDM"},{"code":"361","type":"RC"},{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":511,"maximum":800,"gross_charge":833,"discounted_cash":750,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":800},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":775},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":511}]}]},{"description":"Bone Cement Antibiotic (C)","code_information":[{"code":"4300051","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":511,"maximum":799,"gross_charge":832,"discounted_cash":749,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":799},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":790},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":774},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":511}]}]},{"description":"Or 3.5mm Lcp Plate 6 Hole 223.561","code_information":[{"code":"4300016","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":511,"maximum":799,"gross_charge":832,"discounted_cash":749,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":799},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":790},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":774},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":511}]}]},{"description":"25650 Closed Treatment Of Ulnar Styloid Fracture","code_information":[{"code":"3331747","type":"CDM"},{"code":"521","type":"RC"},{"code":"25650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":510,"maximum":798,"gross_charge":831,"discounted_cash":748,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":773},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":510}]}]},{"description":"Suboxone Charge  48 Hours","code_information":[{"code":"3331677","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":509,"maximum":797,"gross_charge":830,"discounted_cash":747,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":797},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":789},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":772},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":509}]}]},{"description":"Us Duplex Hemodialysis Access Art +Vein","code_information":[{"code":"3740013-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93990","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":508,"maximum":795,"gross_charge":828,"discounted_cash":745,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":795},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":787},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":508}]}]},{"description":"25622 Treat Wrist Bone Fracture","code_information":[{"code":"3332411","type":"CDM"},{"code":"521","type":"RC"},{"code":"25622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":508,"maximum":795,"gross_charge":828,"discounted_cash":745,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":795},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":787},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":770},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":508}]}]},{"description":"Thrombin Topical Recombinant 20,000 Intl Units Pow [Gmh]","code_information":[{"code":"4506090","type":"CDM"},{"code":"250","type":"RC"},{"code":"43825070741","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":507,"maximum":793,"gross_charge":826,"discounted_cash":743,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":793},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":785},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":507},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512}]}],"drug_information":{"unit":20000,"type":"UN"}},{"description":"93242 Extended Holter Monitor Hook Up 3-7 Day Charge","code_information":[{"code":"4050004","type":"CDM"},{"code":"731","type":"RC"},{"code":"93242","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":506,"maximum":792,"gross_charge":825,"discounted_cash":743,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":792},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":767},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":506}]}]},{"description":"93924tc Art Seg & Exer Lower","code_information":[{"code":"4020004-TC","type":"CDM"},{"code":"929","type":"RC"},{"code":"93924","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":506,"maximum":792,"gross_charge":825,"discounted_cash":743,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":792},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":767},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":506}]}]},{"description":"Sleep Study Home","code_information":[{"code":"4100030-TC","type":"CDM"},{"code":"920","type":"RC"},{"code":"95806","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":506,"maximum":792,"gross_charge":825,"discounted_cash":743,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":792},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":784},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":767},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":506}]}]},{"description":"Fosaprepitant 150 Mg Pow [Gmh]","code_information":[{"code":"4502003","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006306102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":505,"maximum":790,"gross_charge":823,"discounted_cash":741,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":518},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":790},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":765},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":510}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Xr Cholangiography Intraoperative","code_information":[{"code":"3700024-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"74300","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":503,"maximum":787,"gross_charge":820,"discounted_cash":738,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":787},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":508},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":779},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":763},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Nm Cardiolyte 99ntc 25 Mci","code_information":[{"code":"4060051","type":"CDM"},{"code":"343","type":"RC"},{"code":"A4641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":503,"maximum":786,"gross_charge":819,"discounted_cash":737,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":508},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":762},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"Nm Tc99 Sestamibi (1 Dose)","code_information":[{"code":"CP17805908877481646","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":503,"maximum":786,"gross_charge":819,"discounted_cash":737,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":786},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":508},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":778},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":762},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":503}]}]},{"description":"93923tc Segmental Pressure Comp","code_information":[{"code":"4020014-TC","type":"CDM"},{"code":"929","type":"RC"},{"code":"93923","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":500,"maximum":782,"gross_charge":815,"discounted_cash":734,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":782},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":774},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":758},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":500}]}]},{"description":"Medium Medial Offloader Brace","code_information":[{"code":"4308997","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308997","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":496,"maximum":776,"gross_charge":808,"discounted_cash":727,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":776},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":496}]}]},{"description":"Family psychotherapy, not including patient, 50 min","code_information":[{"code":"3331323","type":"CDM"},{"code":"916","type":"RC"},{"code":"90846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":494,"maximum":773,"gross_charge":805,"discounted_cash":725,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":507},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":773},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":765},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":749},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":494}]}]},{"description":"57022 Incision And Drainage Of Vaginal Hematoma; Obstetrical/postpartum","code_information":[{"code":"3337023","type":"CDM"},{"code":"57022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":492,"maximum":769,"gross_charge":801,"discounted_cash":721,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":769},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":497},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":761},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":745},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":492}]}]},{"description":"Xr Bone Survey Ltd","code_information":[{"code":"3700112-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"77074","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":491,"maximum":768,"gross_charge":800,"discounted_cash":720,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":491}]}]},{"description":"Swivelock 4.75 Mm X 19.1mm","code_information":[{"code":"4301125","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301125","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":491,"maximum":768,"gross_charge":800,"discounted_cash":720,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":491}]}]},{"description":"23500 Closed Trtmt Of Clavicle Fx W/o Manipulation Charge","code_information":[{"code":"3331693","type":"CDM"},{"code":"521","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":491,"maximum":768,"gross_charge":800,"discounted_cash":720,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":491}]}]},{"description":"26600 Closed Treatment Of Metacarpal Fracture W/o Manipulation","code_information":[{"code":"3336502","type":"CDM"},{"code":"521","type":"RC"},{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":491,"maximum":768,"gross_charge":800,"discounted_cash":720,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":768},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":760},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":491}]}]},{"description":"24560 Closed Treatment Of Humeral Epicondylar Fracture, Medial Or Lateral; Without Manipulation","code_information":[{"code":"3331874","type":"CDM"},{"code":"521","type":"RC"},{"code":"24560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":487,"maximum":762,"gross_charge":794,"discounted_cash":715,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":762},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":754},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":738},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":487}]}]},{"description":"Us Abdomen Ltd","code_information":[{"code":"3740039-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":485,"maximum":758,"gross_charge":790,"discounted_cash":711,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":758},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":485}]}]},{"description":"2.6 Fibertak Softanchor W/suture (C)","code_information":[{"code":"4301165","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301165","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":485,"maximum":758,"gross_charge":790,"discounted_cash":711,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":758},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":485}]}]},{"description":"Trabeculectomy Stand Alone Procedure ( Sightpath )","code_information":[{"code":"4300931","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300931","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":485,"maximum":758,"gross_charge":790,"discounted_cash":711,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":758},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":735},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":485}]}]},{"description":"25630 Closed Treatment Of Carpal Bone Fracture; W/o Manipulation, Each Bone","code_information":[{"code":"3331721","type":"CDM"},{"code":"521","type":"RC"},{"code":"25630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":484,"maximum":757,"gross_charge":789,"discounted_cash":710,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":497},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":757},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":489},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":750},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":734},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":484}]}]},{"description":"Or 3.5mm Lcp Plate 5 Hole 223.551","code_information":[{"code":"4300015","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":480,"maximum":751,"gross_charge":782,"discounted_cash":704,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":751},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":743},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":727},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":480}]}]},{"description":"Us Scrotum +Contents","code_information":[{"code":"3740035-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":476,"maximum":744,"gross_charge":775,"discounted_cash":698,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":744},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":736},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":721},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":476}]}]},{"description":"13151 Repair Complex Eyelid/nose/ear/lip 1.1-2.5 Cm","code_information":[{"code":"3331904","type":"CDM"},{"code":"361","type":"RC"},{"code":"13151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":474,"maximum":742,"gross_charge":773,"discounted_cash":696,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":742},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":734},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":719},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":474}]}]},{"description":"26700 Closed Trtmt Metacarpophalangeal Dislc W/manipulation W/o Anes","code_information":[{"code":"3331696","type":"CDM"},{"code":"521","type":"RC"},{"code":"26700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":474,"maximum":741,"gross_charge":772,"discounted_cash":695,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":741},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":733},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":718},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":474}]}]},{"description":"26770 Closed Reduction Of Dislocation Of Single Interphalangeal Joint With Manipulation; W/o Anesthe","code_information":[{"code":"3332469","type":"CDM"},{"code":"521","type":"RC"},{"code":"26770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":474,"maximum":741,"gross_charge":772,"discounted_cash":695,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":741},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":733},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":718},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":474}]}]},{"description":"Psychotherapy, 60 min","code_information":[{"code":"3331322","type":"CDM"},{"code":"914","type":"RC"},{"code":"90837","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":473,"maximum":739,"gross_charge":770,"discounted_cash":693,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":739},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":732},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":473}]}]},{"description":"93246 Extended Holter Monitor Hook Up 8-15 Day Charge","code_information":[{"code":"4050005","type":"CDM"},{"code":"731","type":"RC"},{"code":"93246","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":471,"maximum":736,"gross_charge":767,"discounted_cash":690,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":483},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":736},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":729},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":471}]}]},{"description":"Bupivacaine-meloxicam 400 Mg-12 Mg/14 Ml Ers [Gmh]","code_information":[{"code":"4507176","type":"CDM"},{"code":"250","type":"RC"},{"code":"47426050102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":468,"maximum":732,"gross_charge":763,"discounted_cash":687,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":732},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":710},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":473}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Us Transrectal","code_information":[{"code":"3740046-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76872","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":466,"maximum":730,"gross_charge":760,"discounted_cash":684,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":730},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":722},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":707},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":466}]}]},{"description":"Psychotherapy, 45 min","code_information":[{"code":"3331321","type":"CDM"},{"code":"914","type":"RC"},{"code":"90834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":463,"maximum":725,"gross_charge":755,"discounted_cash":680,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":717},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":463}]}]},{"description":"C7901 30-60 Min.  Remote Service Individual Psychotherapy","code_information":[{"code":"3331328","type":"CDM"},{"code":"915","type":"RC"},{"code":"C7901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":463,"maximum":725,"gross_charge":755,"discounted_cash":680,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":476},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":725},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":717},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":702},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":463}]}]},{"description":"24650 Closed Treatment Of Radial Head Or Neck Fracture; W/o Manipulation","code_information":[{"code":"3331739","type":"CDM"},{"code":"521","type":"RC"},{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":463,"maximum":724,"gross_charge":754,"discounted_cash":679,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":724},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":716},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":701},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":463}]}]},{"description":"15275 Apply Skin Sub To Head, Genitalia, Hands,feet; First 25 Sq Cm","code_information":[{"code":"3331813","type":"CDM"},{"code":"510","type":"RC"},{"code":"15275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":460,"maximum":720,"gross_charge":750,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"Us Extremity Nonvascular Bil","code_information":[{"code":"4040008-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":460,"maximum":720,"gross_charge":750,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"Us Superficial","code_information":[{"code":"3740031-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":460,"maximum":720,"gross_charge":750,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"Xr Fluoro Up To 1 Hour","code_information":[{"code":"3700054-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":460,"maximum":720,"gross_charge":750,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"31500 Rt Intubation-airway Management Charge","code_information":[{"code":"3900103","type":"CDM"},{"code":"410","type":"RC"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":460,"maximum":720,"gross_charge":750,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"94060 Spirometry Pre And Post Bronchodilator Charge","code_information":[{"code":"3900106","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":460,"maximum":720,"gross_charge":750,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"Blepharoplasty ( Sightpath )","code_information":[{"code":"4300928","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300928","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":460,"maximum":720,"gross_charge":750,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"Ectropian/entropian ( Sightpath )","code_information":[{"code":"4300929","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300929","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":460,"maximum":720,"gross_charge":750,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":720},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":713},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":460}]}]},{"description":"Groshong Kit 9.5fr","code_information":[{"code":"4300756","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300756","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":459,"maximum":718,"gross_charge":748,"discounted_cash":673,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":718},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":711},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":459}]}]},{"description":"Oa Medial Right Knee Brace","code_information":[{"code":"4302409","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302409","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":457,"maximum":715,"gross_charge":745,"discounted_cash":671,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":715},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":457}]}]},{"description":"Us Fetal Echo 2d","code_information":[{"code":"3740071-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76825","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":455,"maximum":711,"gross_charge":741,"discounted_cash":667,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":711},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":704},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":689},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":455}]}]},{"description":"Cervical Traction Device","code_information":[{"code":"4302300","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302300","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":453,"maximum":708,"gross_charge":738,"discounted_cash":664,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":701},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":686},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":453}]}]},{"description":"Group psychotherapy","code_information":[{"code":"3331325","type":"CDM"},{"code":"915","type":"RC"},{"code":"90853","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":451,"maximum":706,"gross_charge":735,"discounted_cash":662,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":451}]}]},{"description":"C7903 Remote Service Group Psychotherapy","code_information":[{"code":"3331865","type":"CDM"},{"code":"915","type":"RC"},{"code":"C7903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":451,"maximum":706,"gross_charge":735,"discounted_cash":662,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":451}]}]},{"description":"G0410 Iop Only45-50 Min Group Psychotherapy","code_information":[{"code":"3331866","type":"CDM"},{"code":"915","type":"RC"},{"code":"G0410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":451,"maximum":706,"gross_charge":735,"discounted_cash":662,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":451}]}]},{"description":"Suture Anchor 6.5 (C)","code_information":[{"code":"4301072","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301072","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":451,"maximum":706,"gross_charge":735,"discounted_cash":662,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":451}]}]},{"description":"25560 Closed Treatment Of Radial And Ulnar Shaft Fractures; W/o Manipulation","code_information":[{"code":"3331744","type":"CDM"},{"code":"521","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":451,"maximum":706,"gross_charge":735,"discounted_cash":662,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":706},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":451}]}]},{"description":"13120 Repair Complex Scalp/arm/leg 1.1-2.5 Cm","code_information":[{"code":"3331901","type":"CDM"},{"code":"361","type":"RC"},{"code":"13120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450,"maximum":704,"gross_charge":733,"discounted_cash":660,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":704},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":454},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":696},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":450}]}]},{"description":"Meningococcal Conjugate Vaccine Group Acyw Sol","code_information":[{"code":"4507098","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":447,"maximum":700,"gross_charge":729,"discounted_cash":656,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":700},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":693},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":678},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rsv Vaccine, Pref A-pref B, Recombinant Preservative-free 60 Mcg-60 Mcg Pow [Gmh]","code_information":[{"code":"4507158","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069246510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":447,"maximum":699,"gross_charge":728,"discounted_cash":655,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":699},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":692},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":677},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"11046 Debridement,skin And/or Muscle (Ea Add'l 20 Sq Cm).","code_information":[{"code":"3331888","type":"CDM"},{"code":"361","type":"RC"},{"code":"11046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":446,"maximum":698,"gross_charge":727,"discounted_cash":654,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":698},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":676},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":446}]}]},{"description":"Coblation Halo Wand (C)","code_information":[{"code":"4300654","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300654","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":443,"maximum":692,"gross_charge":721,"discounted_cash":649,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":454},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":692},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":685},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":671},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":443}]}]},{"description":"C-qur V Patch Mesh Small 1.7 X 1.7","code_information":[{"code":"4300794","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300794","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":442,"maximum":691,"gross_charge":720,"discounted_cash":648,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":454},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":442}]}]},{"description":"Acetylcysteine 20% Iv Sol 30 Ml [Gmh]","code_information":[{"code":"4502014","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150025930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":442,"maximum":691,"gross_charge":720,"discounted_cash":648,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":454},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":691},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":684},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":670},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"21320 Closed Tx Nose Fx W/ Stablj.","code_information":[{"code":"3332404","type":"CDM"},{"code":"521","type":"RC"},{"code":"21320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":441,"maximum":689,"gross_charge":718,"discounted_cash":646,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":689},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":441}]}]},{"description":"25530 Treat Fracture Of Ulna","code_information":[{"code":"3332409","type":"CDM"},{"code":"521","type":"RC"},{"code":"25530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":441,"maximum":689,"gross_charge":718,"discounted_cash":646,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":689},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":441}]}]},{"description":"Suture Anchor Size 5.5 (C)","code_information":[{"code":"4301071","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301071","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":439,"maximum":686,"gross_charge":715,"discounted_cash":644,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":686},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":679},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":439}]}]},{"description":"Groshong Kit 8fr","code_information":[{"code":"4300732","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300732","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":436,"maximum":683,"gross_charge":711,"discounted_cash":640,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":448},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":683},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":661},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":436}]}]},{"description":"96413 Chemo Iv Up To 1 Hr Charge","code_information":[{"code":"4401120","type":"CDM"},{"code":"280","type":"RC"},{"code":"96413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436,"maximum":682,"gross_charge":710,"discounted_cash":639,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":436}]}]},{"description":"11444 Exc Ben Face/ear/eyelid/nose/..3.1-4.0cm","code_information":[{"code":"3331997","type":"CDM"},{"code":"521","type":"RC"},{"code":"11444","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436,"maximum":682,"gross_charge":710,"discounted_cash":639,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":682},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":436}]}]},{"description":"24670 Closed Treatment Of Ulnar Fracture, Proximal End; W/o Manipulation.","code_information":[{"code":"3331749","type":"CDM"},{"code":"521","type":"RC"},{"code":"24670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":432,"maximum":675,"gross_charge":703,"discounted_cash":633,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":443},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":668},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":432}]}]},{"description":"Palonosetron 0.25 Mg/5 Ml Iv Sol [Gmh]","code_information":[{"code":"4501024","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150018605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":430,"maximum":673,"gross_charge":701,"discounted_cash":631,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":673},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":666},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":652},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":435}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Aph Rbc Cp2d As3 Lr 1","code_information":[{"code":"3820155","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":430,"maximum":672,"gross_charge":700,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"Rbc Cpd As1 450 Lr","code_information":[{"code":"3820100","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":430,"maximum":672,"gross_charge":700,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"Tc99m Mertiatide Per Vial (Mag 3)","code_information":[{"code":"4060015","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":430,"maximum":672,"gross_charge":700,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"Us Guide Intraoperative","code_information":[{"code":"3740019-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76998","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":430,"maximum":672,"gross_charge":700,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"Us Guide Ndl Placement","code_information":[{"code":"3740018-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":430,"maximum":672,"gross_charge":700,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"Xr Spine Lumbosacral Comp W/ Bending","code_information":[{"code":"3700030-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":430,"maximum":672,"gross_charge":700,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"94726 Plethysmography Charge","code_information":[{"code":"3900109","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":430,"maximum":672,"gross_charge":700,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"Oa Brace Medial Rt Lg","code_information":[{"code":"4302411","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302411","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":430,"maximum":672,"gross_charge":700,"discounted_cash":630,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":672},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":430}]}]},{"description":"Glucagon Recombinant 1 Mg Inj [Gmh]","code_information":[{"code":"4501175","type":"CDM"},{"code":"250","type":"RC"},{"code":"00548585000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":425,"maximum":664,"gross_charge":692,"discounted_cash":623,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":664},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":429},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":657},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":429}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"93924 Abi W/ Excercise","code_information":[{"code":"4067050-TC","type":"CDM"},{"code":"929","type":"RC"},{"code":"93924","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":424,"maximum":662,"gross_charge":690,"discounted_cash":621,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":424}]}]},{"description":"27780 Closed Treatment Of Proximal Fibula Or Shaft Fracture; Without Manipulation","code_information":[{"code":"3331746","type":"CDM"},{"code":"521","type":"RC"},{"code":"27780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":424,"maximum":662,"gross_charge":690,"discounted_cash":621,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":424}]}]},{"description":"Tribute Night Toes To Knee","code_information":[{"code":"4308101","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308101","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":660,"gross_charge":688,"discounted_cash":619,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":654},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":640},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"10010 Fine Ndl Aspiration Biopsy, Ct, Each Additional Lesion","code_information":[{"code":"3740030","type":"CDM"},{"code":"320","type":"RC"},{"code":"10010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":660,"gross_charge":687,"discounted_cash":618,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":660},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":653},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":639},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":422}]}]},{"description":"Oa Evday Medial Rt","code_information":[{"code":"4304023","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":415,"maximum":649,"gross_charge":676,"discounted_cash":608,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":642},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":415}]}]},{"description":"Pft Pulmonary Function Pre/post Gbmh Cp","code_information":[{"code":"4000054","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":414,"maximum":648,"gross_charge":675,"discounted_cash":608,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":425},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":648},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":628},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":414}]}]},{"description":"Us Abdomen Aorta Ltd","code_information":[{"code":"3740033-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":411,"maximum":643,"gross_charge":670,"discounted_cash":603,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":643},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":411}]}]},{"description":"Us Renal Comp","code_information":[{"code":"3654500-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":411,"maximum":643,"gross_charge":670,"discounted_cash":603,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":643},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":411}]}]},{"description":"Scissor Sealer/divider","code_information":[{"code":"4304040","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":411,"maximum":643,"gross_charge":670,"discounted_cash":603,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":643},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":411}]}]},{"description":"Tubular Plate Lcp 6 Hole 241.361","code_information":[{"code":"4309110","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309110","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":410,"maximum":641,"gross_charge":668,"discounted_cash":601,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":635},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":621},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":410}]}]},{"description":"Tubular Plate Lcp 5 Hole 241.351","code_information":[{"code":"4309112","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309112","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":410,"maximum":641,"gross_charge":668,"discounted_cash":601,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":641},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":635},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":621},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":410}]}]},{"description":"11623 Excision, Malign Lesion; Scalp, Neck, Hand, Feet, Genital (2.1-3cm)","code_information":[{"code":"3332457","type":"CDM"},{"code":"521","type":"RC"},{"code":"11623","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":636,"gross_charge":662,"discounted_cash":596,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"23570  Closed Treatment Of Scapular Fracture; W/o Manipulation.","code_information":[{"code":"3332460","type":"CDM"},{"code":"521","type":"RC"},{"code":"23570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":636,"gross_charge":662,"discounted_cash":596,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"28400 Treatment Of Heel Fracture","code_information":[{"code":"3332416","type":"CDM"},{"code":"521","type":"RC"},{"code":"28400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":636,"gross_charge":662,"discounted_cash":596,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"28470 Treat Metatarsal Fracture","code_information":[{"code":"3332417","type":"CDM"},{"code":"521","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":406,"maximum":636,"gross_charge":662,"discounted_cash":596,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":636},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":616},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":406}]}]},{"description":"Layer Closure Of Wounds Of Scalp, Axillae, Trunk, Extremities(exclude Hands And Feet) 2.6 Cm To 07.5","code_information":[{"code":"3331282","type":"CDM"},{"code":"450","type":"RC"},{"code":"12032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":404,"maximum":633,"gross_charge":659,"discounted_cash":593,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":633},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":626},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":613},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":404}]}]},{"description":"Eye Pack Custom","code_information":[{"code":"4300365","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300365","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":404,"maximum":632,"gross_charge":658,"discounted_cash":592,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":625},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":612},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":404}]}]},{"description":"Trocar Endo Balloon 10mm","code_information":[{"code":"4300240","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300240","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":404,"maximum":632,"gross_charge":658,"discounted_cash":592,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":632},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":625},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":612},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":404}]}]},{"description":"Laceration Repair Intermediate 2.5-30 Cmscalp/trunk/extremities","code_information":[{"code":"3331221","type":"CDM"},{"code":"450","type":"RC"},{"code":"12034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":403,"maximum":630,"gross_charge":656,"discounted_cash":590,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":610},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":403}]}]},{"description":"Peg Tube Tray","code_information":[{"code":"4301171","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301171","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":403,"maximum":630,"gross_charge":656,"discounted_cash":590,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":630},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":610},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":403}]}]},{"description":"Resolution Clip 235cm ( C )","code_information":[{"code":"4308100","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":402,"maximum":629,"gross_charge":655,"discounted_cash":590,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":629},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":609},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":402}]}]},{"description":"13131 Repair Complex F/c/c/m/n/ax/g/h/f 1.1-2.5 Cm","code_information":[{"code":"3331902","type":"CDM"},{"code":"361","type":"RC"},{"code":"13131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":401,"maximum":627,"gross_charge":653,"discounted_cash":588,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":627},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":620},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":607},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":401}]}]},{"description":"99283fac Ed Level 3room Charge","code_information":[{"code":"3601203","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":399,"maximum":624,"gross_charge":650,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"G0176 Iop Only45 Min Activity Therapy","code_information":[{"code":"3331867","type":"CDM"},{"code":"904","type":"RC"},{"code":"G0176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":399,"maximum":624,"gross_charge":650,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"G0177 Iop Only45 Min Train And Educate","code_information":[{"code":"3331868","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":399,"maximum":624,"gross_charge":650,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Breast Comp Lt.","code_information":[{"code":"3740010-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":399,"maximum":624,"gross_charge":650,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Breast Comp Rt.","code_information":[{"code":"3740005-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":399,"maximum":624,"gross_charge":650,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Us Chest","code_information":[{"code":"3740012-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":399,"maximum":624,"gross_charge":650,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"4.5x14mm Bc Corkscrew Ft Dx","code_information":[{"code":"4301173","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301173","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":399,"maximum":624,"gross_charge":650,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Hernia Plug Med","code_information":[{"code":"4300771","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300771","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":399,"maximum":624,"gross_charge":650,"discounted_cash":585,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":410},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":624},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":618},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":399}]}]},{"description":"Ligasure Precise Handpiece","code_information":[{"code":"4300296","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300296","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":398,"maximum":623,"gross_charge":649,"discounted_cash":584,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":617},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":398}]}]},{"description":"57558 Dilation And Curettage Of Cervical Stump","code_information":[{"code":"3337086","type":"CDM"},{"code":"57558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":398,"maximum":623,"gross_charge":649,"discounted_cash":584,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":617},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":398}]}]},{"description":"Ceftaroline 600 Mg Pow [Gmh]","code_information":[{"code":"4505087","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456060010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":392,"maximum":612,"gross_charge":638,"discounted_cash":574,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":612},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":606},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":396}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"92953 Temp Transcutaneous Pacing","code_information":[{"code":"3331948","type":"CDM"},{"code":"361","type":"RC"},{"code":"92953","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":389,"maximum":609,"gross_charge":634,"discounted_cash":571,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":609},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":389}]}]},{"description":"11760 Repair Of Nail Bed.","code_information":[{"code":"3332468","type":"CDM"},{"code":"521","type":"RC"},{"code":"11760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":389,"maximum":609,"gross_charge":634,"discounted_cash":571,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":609},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":602},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":389}]}]},{"description":"Securestrap Staple Device ( 12 )","code_information":[{"code":"4301723","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301723","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":387,"maximum":605,"gross_charge":630,"discounted_cash":567,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":605},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":599},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":387}]}]},{"description":"Us Axilla Lt","code_information":[{"code":"3740021-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":384,"maximum":600,"gross_charge":625,"discounted_cash":563,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":384}]}]},{"description":"Us Extremity Nonvascular Lt","code_information":[{"code":"4040006-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":384,"maximum":600,"gross_charge":625,"discounted_cash":563,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":384}]}]},{"description":"Us Extremity Nonvascular Rt","code_information":[{"code":"4040007-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":384,"maximum":600,"gross_charge":625,"discounted_cash":563,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":600},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":384}]}]},{"description":"Regadenoson 0.4 Mg/5 Ml Iv Sol 5 Ml [Gmh]","code_information":[{"code":"4501445","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505611600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":381,"maximum":596,"gross_charge":621,"discounted_cash":559,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":596},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":590},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":578},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"33286 Removal, Subcutaneous Cardiac Rhythm Monitor","code_information":[{"code":"3331995","type":"CDM"},{"code":"521","type":"RC"},{"code":"33286","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":380,"maximum":594,"gross_charge":619,"discounted_cash":557,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":594},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":588},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":380}]}]},{"description":"Budesonide-formoterol 160 Mcg-4.5 Mcg/inh Aer [Gmh]","code_information":[{"code":"4506098","type":"CDM"},{"code":"250","type":"RC"},{"code":"00186037028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":379,"maximum":593,"gross_charge":618,"discounted_cash":556,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":587},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":575},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":383}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Topotecan 4 Mg Pow [Gmh]","code_information":[{"code":"CP17805909631707394","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323076294","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":377,"maximum":589,"gross_charge":614,"discounted_cash":553,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":387},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":589},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":571},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Psychotherapy, 30 min","code_information":[{"code":"3331320","type":"CDM"},{"code":"914","type":"RC"},{"code":"90832","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":374,"maximum":586,"gross_charge":610,"discounted_cash":549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":580},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":374}]}]},{"description":"C7900 Remote Service Individual Psychotherapy; Must Be 16 Minutes, All Individuals Located In Home","code_information":[{"code":"3331327","type":"CDM"},{"code":"914","type":"RC"},{"code":"C7900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":374,"maximum":586,"gross_charge":610,"discounted_cash":549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":580},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":374}]}]},{"description":"Suboxone Charge  04 Hours","code_information":[{"code":"3331676","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":374,"maximum":586,"gross_charge":610,"discounted_cash":549,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":586},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":580},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":374}]}]},{"description":"S Curve Dilator Multi-pack (C)","code_information":[{"code":"4300210","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300210","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":373,"maximum":583,"gross_charge":607,"discounted_cash":546,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":583},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":565},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":373}]}]},{"description":"Xr Abdomen Comp +Chest 1 View","code_information":[{"code":"3700004-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":371,"maximum":581,"gross_charge":605,"discounted_cash":545,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":575},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":563},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":371}]}]},{"description":"Cerclage Tensioner (C)","code_information":[{"code":"4302075","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302075","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":371,"maximum":581,"gross_charge":605,"discounted_cash":545,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":575},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":563},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":371}]}]},{"description":"11424 Excision, Benign Lesion (Except Skin Tag) Scalp, Neck, Hands, Feet, Genital (3.1-4cm)","code_information":[{"code":"3332471","type":"CDM"},{"code":"521","type":"RC"},{"code":"11424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":369,"maximum":577,"gross_charge":601,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":571},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":369}]}]},{"description":"Us Abi Limited","code_information":[{"code":"3740048-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93922","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":368,"maximum":576,"gross_charge":600,"discounted_cash":540,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":368}]}]},{"description":"Us Pregnant Detailed 1st Gest","code_information":[{"code":"3740059","type":"CDM"},{"code":"510","type":"RC"},{"code":"76811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":368,"maximum":576,"gross_charge":600,"discounted_cash":540,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":368}]}]},{"description":"X-Ray of lower back","code_information":[{"code":"3700064-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":368,"maximum":576,"gross_charge":600,"discounted_cash":540,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":368}]}]},{"description":"94729 Dlco Charge","code_information":[{"code":"3900111","type":"CDM"},{"code":"460","type":"RC"},{"code":"94729","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":368,"maximum":576,"gross_charge":600,"discounted_cash":540,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":368}]}]},{"description":"Pterygium Excision ( Sightpath )","code_information":[{"code":"4300930","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300930","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":368,"maximum":576,"gross_charge":600,"discounted_cash":540,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":576},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":570},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":368}]}]},{"description":"Bupivacaine Liposome 1.3% 10ml (13.3 Mg/ml) Sus [Gmh]","code_information":[{"code":"4507113","type":"CDM"},{"code":"250","type":"RC"},{"code":"65250013304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":368,"maximum":575,"gross_charge":599,"discounted_cash":539,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":575},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":569},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":557},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Ciprofloxacin-dexamethasone Otic 0.3%-0.1% Sus[gmh]","code_information":[{"code":"4506058","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078079975","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":367,"maximum":574,"gross_charge":598,"discounted_cash":538,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":574},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":568},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Troponin Roll Up82553, 83874 And 84484","code_information":[{"code":"28942731","type":"CDM"},{"code":"301","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":363,"maximum":567,"gross_charge":591,"discounted_cash":532,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":550},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":363}]}]},{"description":"26720 Treat Finger Fracture Each","code_information":[{"code":"3332413","type":"CDM"},{"code":"521","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":363,"maximum":567,"gross_charge":591,"discounted_cash":532,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":550},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":363}]}]},{"description":"Epirubicin 2 Mg/ml Sol 100 Ml [Gmh]","code_information":[{"code":"CP17805909631470042","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009509301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":361,"maximum":564,"gross_charge":588,"discounted_cash":529,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":564},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":559},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":365}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Xr Ribs Min 4 Views Bil W/ Pa Chest","code_information":[{"code":"3700119-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":359,"maximum":562,"gross_charge":585,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":562},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":544},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":359}]}]},{"description":"31500 Intubation Endotracheal","code_information":[{"code":"3331938","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":358,"maximum":561,"gross_charge":584,"discounted_cash":526,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":561},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":555},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":358}]}]},{"description":"Evac 70 Xtra Hp Wand","code_information":[{"code":"4300874","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300874","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":356,"maximum":557,"gross_charge":580,"discounted_cash":522,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":557},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":551},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":539},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":356}]}]},{"description":"Xr Shoulder Comp Min 2 Views Rt","code_information":[{"code":"3700096-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":355,"maximum":555,"gross_charge":578,"discounted_cash":520,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":555},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":549},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":355}]}]},{"description":"12052 Repair Intermed F/e/e/n/l&/muc 2.6-5.0 Cm","code_information":[{"code":"3331899","type":"CDM"},{"code":"361","type":"RC"},{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":353,"maximum":552,"gross_charge":575,"discounted_cash":518,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":353}]}]},{"description":"Bill Tissue Processing, Level V","code_information":[{"code":"3800805","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":353,"maximum":552,"gross_charge":575,"discounted_cash":518,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":353}]}]},{"description":"Xr Spine Cerv Comp","code_information":[{"code":"3700033-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":353,"maximum":552,"gross_charge":575,"discounted_cash":518,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":353}]}]},{"description":"Xr Spine Scoliosis Standing","code_information":[{"code":"3700095-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72083","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":353,"maximum":552,"gross_charge":575,"discounted_cash":518,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":552},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":546},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":353}]}]},{"description":"Layer Closure Of Wounds Of Neck, Hands, Feet And/or Ext Genitalia; 2.6 Cm To 7.5 Cm  Charge","code_information":[{"code":"3331297","type":"CDM"},{"code":"450","type":"RC"},{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":352,"maximum":550,"gross_charge":573,"discounted_cash":516,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":550},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":544},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":533},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":352}]}]},{"description":"Layer Closure Of Wounds Of Face, Ear, Eyelid, Nose, Lip, Mucous Membrane 2.5 Cm Or Less Charge","code_information":[{"code":"3333052","type":"CDM"},{"code":"450","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350,"maximum":547,"gross_charge":570,"discounted_cash":513,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"Xr Spine Thoracic 3 Views","code_information":[{"code":"3700108-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":350,"maximum":547,"gross_charge":570,"discounted_cash":513,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":547},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":542},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":350}]}]},{"description":"12051 Repair Intermediate F/e/e/n/l&/muc < 2.5 Cm","code_information":[{"code":"3331898","type":"CDM"},{"code":"360","type":"RC"},{"code":"12051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":346,"maximum":540,"gross_charge":563,"discounted_cash":507,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":346}]}]},{"description":"Linear Cutter 45mm","code_information":[{"code":"4301709","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301709","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":345,"maximum":540,"gross_charge":562,"discounted_cash":506,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":345}]}]},{"description":"13153 Repair Complex Eyelid/nose/ear/lip Ea Addl 5 Cm","code_information":[{"code":"3331906","type":"CDM"},{"code":"361","type":"RC"},{"code":"13153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":344,"maximum":538,"gross_charge":560,"discounted_cash":504,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":344}]}]},{"description":"Bflex Bronchoscope (C)","code_information":[{"code":"3500310","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500310","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":344,"maximum":538,"gross_charge":560,"discounted_cash":504,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":538},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":344}]}]},{"description":"Cholangiogram Catheter (C)","code_information":[{"code":"4300936","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300936","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":343,"maximum":537,"gross_charge":559,"discounted_cash":503,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":537},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":343}]}]},{"description":"Xr Bone Survey Infant","code_information":[{"code":"3700200-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"77076","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":342,"maximum":535,"gross_charge":557,"discounted_cash":501,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":518},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":342}]}]},{"description":"46900 Destruction Anal Lesion(s).","code_information":[{"code":"3332421","type":"CDM"},{"code":"521","type":"RC"},{"code":"46900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":342,"maximum":535,"gross_charge":557,"discounted_cash":501,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":518},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":342}]}]},{"description":"27200 Closed Treatment Of Coccygeal Fracture","code_information":[{"code":"3331694","type":"CDM"},{"code":"521","type":"RC"},{"code":"27200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":341,"maximum":533,"gross_charge":555,"discounted_cash":500,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":533},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":516},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":341}]}]},{"description":"43762 Chg Gastrostomy Tube Percutaneous W/o Gdnce","code_information":[{"code":"3331941","type":"CDM"},{"code":"361","type":"RC"},{"code":"43762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339,"maximum":530,"gross_charge":552,"discounted_cash":497,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":339}]}]},{"description":"11443 Exc Face-mm B9+marg 2.1-3 Cm.","code_information":[{"code":"3332402","type":"CDM"},{"code":"521","type":"RC"},{"code":"11443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339,"maximum":530,"gross_charge":552,"discounted_cash":497,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":339}]}]},{"description":"Human Papilloma Virus (Hpv) Vaccine Poc","code_information":[{"code":"3332242","type":"CDM"},{"code":"636","type":"RC"},{"code":"90651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":338,"maximum":529,"gross_charge":551,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":338}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Bd Dexa Axial Skeleton","code_information":[{"code":"1180001-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":338,"maximum":528,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":338}]}]},{"description":"Us Thyroid Biopsy","code_information":[{"code":"3740027","type":"CDM"},{"code":"360","type":"RC"},{"code":"60100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":338,"maximum":528,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":338}]}]},{"description":"Xr Abdomen Comp","code_information":[{"code":"3700003-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"74021","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":338,"maximum":528,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":338}]}]},{"description":"Xr Skull Comp Min 4 Views","code_information":[{"code":"3700100-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":338,"maximum":528,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":338}]}]},{"description":"Fibertak Kit","code_information":[{"code":"4301137","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301137","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":338,"maximum":528,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":338}]}]},{"description":"Pupil Dilators ( Sightpath )","code_information":[{"code":"4300922","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300922","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":338,"maximum":528,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":338}]}]},{"description":"Trabeculectomy Cataract Procedure ( Sightpath )","code_information":[{"code":"4300933","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300933","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":338,"maximum":528,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":338}]}]},{"description":"99214 Allergy Serum + Office Visit Level 4 Established","code_information":[{"code":"3331681","type":"CDM"},{"code":"521","type":"RC"},{"code":"99214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":338,"maximum":528,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":338}]}]},{"description":"Fibrin Sealant Topicalsol [Gmh]","code_information":[{"code":"4500226","type":"CDM"},{"code":"250","type":"RC"},{"code":"00944840204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":338,"maximum":528,"gross_charge":550,"discounted_cash":495,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":523},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":341}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epoetin Alfa Epbx 20,000 Units/ml Sol [Gmh]","code_information":[{"code":"4507175","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069131110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":337,"maximum":527,"gross_charge":549,"discounted_cash":494,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":511},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":340}]}],"drug_information":{"unit":20000,"type":"UN"}},{"description":"Multivitamin Soln [Gmh]","code_information":[{"code":"4501825","type":"CDM"},{"code":"250","type":"RC"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":337,"maximum":527,"gross_charge":549,"discounted_cash":494,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":511},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":340}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Advincula Uterine Manipulator","code_information":[{"code":"4303043","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303043","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":337,"maximum":527,"gross_charge":549,"discounted_cash":494,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":522},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":511},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":337}]}]},{"description":"57120 Colpocleisis (Le Fort Type)","code_information":[{"code":"3337050","type":"CDM"},{"code":"57120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":336,"maximum":526,"gross_charge":548,"discounted_cash":493,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":526},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":336}]}]},{"description":"Pleurx Pt Starter Kit","code_information":[{"code":"4303053","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303053","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":335,"maximum":524,"gross_charge":546,"discounted_cash":491,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":508},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":335}]}]},{"description":"42160 Treatment Mouth Roof Lesion.","code_information":[{"code":"3332419","type":"CDM"},{"code":"521","type":"RC"},{"code":"42160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":335,"maximum":524,"gross_charge":546,"discounted_cash":491,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":508},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":335}]}]},{"description":"Rabies Vaccine Im Charge","code_information":[{"code":"3334137","type":"CDM"},{"code":"636","type":"RC"},{"code":"90675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":331,"maximum":518,"gross_charge":540,"discounted_cash":486,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":518},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":513},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":502},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":331}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Fusion Oa Brace L Lg (C)","code_information":[{"code":"4300616","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300616","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":331,"maximum":517,"gross_charge":539,"discounted_cash":485,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":340},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":517},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":512},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":501},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":331}]}]},{"description":"Room/bed: Respite","code_information":[{"code":"4620040","type":"CDM"},{"code":"655","type":"RC"},{"code":"CP4620040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":327,"maximum":511,"gross_charge":532,"discounted_cash":479,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":511},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":505},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":495},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":327}]}]},{"description":"Layer Closure Of Wounds Of Scalp, Axillae, Trunk, Extremities(exclude Hands And Feet) 2.5 Cm Or Less","code_information":[{"code":"3331206","type":"CDM"},{"code":"450","type":"RC"},{"code":"12031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":325,"maximum":509,"gross_charge":530,"discounted_cash":477,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":325}]}]},{"description":"Xr Ribs Min 4 Views Bil","code_information":[{"code":"3700090-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":325,"maximum":509,"gross_charge":530,"discounted_cash":477,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":325}]}]},{"description":"Vasopressin 20 Units/ml 1 Ml Inj Sol [Gmh]","code_information":[{"code":"4503001","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023016410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":325,"maximum":509,"gross_charge":530,"discounted_cash":477,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":509},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":329}]}],"drug_information":{"unit":20,"type":"UN"}},{"description":"Indocyanine Green 25 Mg Pow [Gmh]","code_information":[{"code":"4507141","type":"CDM"},{"code":"250","type":"RC"},{"code":"70100042402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":325,"maximum":508,"gross_charge":529,"discounted_cash":476,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":508},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":328}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"93922 Abi","code_information":[{"code":"4067025-TC","type":"CDM"},{"code":"929","type":"RC"},{"code":"93922","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":322,"maximum":504,"gross_charge":525,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Us Echo Doppler Color Flow Mapping","code_information":[{"code":"4040001-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93325","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":322,"maximum":504,"gross_charge":525,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Xr Spine Lumbosacral 2 Or 3 Views","code_information":[{"code":"3700062-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":322,"maximum":504,"gross_charge":525,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"94727 Lung Volume (Gas Diultion Or Washout)","code_information":[{"code":"3900110","type":"CDM"},{"code":"460","type":"RC"},{"code":"94727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":504,"gross_charge":525,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Initial Nursing Facility Care (History, Examination And Mdm Of Moderate Complexity)","code_information":[{"code":"3332271","type":"CDM"},{"code":"525","type":"RC"},{"code":"99305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322,"maximum":504,"gross_charge":525,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":499},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Us Pregnant Detailed Ea Addl Gest","code_information":[{"code":"3740060-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76812","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":322,"maximum":503,"gross_charge":524,"discounted_cash":472,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":322}]}]},{"description":"Mmr/varicella Vaccine Charge","code_information":[{"code":"1110136004","type":"CDM"},{"code":"636","type":"RC"},{"code":"90710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":320,"maximum":500,"gross_charge":521,"discounted_cash":469,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":495},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":320}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Round Burr 4.0mm","code_information":[{"code":"4309701","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309701","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":315,"maximum":492,"gross_charge":513,"discounted_cash":462,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":492},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":315}]}]},{"description":"Nm Myo Perf Eject Frac","code_information":[{"code":"4060065","type":"CDM"},{"code":"341","type":"RC"},{"code":"78480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":313,"maximum":490,"gross_charge":510,"discounted_cash":459,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":313}]}]},{"description":"Puraplyam Mz 100mg","code_information":[{"code":"4308111","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308111","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":313,"maximum":490,"gross_charge":510,"discounted_cash":459,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":490},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":313}]}]},{"description":"Cygnus Dual 4x4","code_information":[{"code":"4308119","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":311,"maximum":486,"gross_charge":506,"discounted_cash":455,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":311}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"General Panel","code_information":[{"code":"3800222","type":"CDM"},{"code":"301","type":"RC"},{"code":"80050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":310,"maximum":485,"gross_charge":505,"discounted_cash":455,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":485},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":310}]}]},{"description":"Adhesion Reduction Sol4% Icodextrin Sol [Gmh]","code_information":[{"code":"4500822","type":"CDM"},{"code":"250","type":"RC"},{"code":"00000600041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":309,"maximum":484,"gross_charge":504,"discounted_cash":454,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":469},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"96409 Chemo Iv Push-single/init Sub Charge","code_information":[{"code":"4401133","type":"CDM"},{"code":"280","type":"RC"},{"code":"96409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Us Pregnant < 14 Weeks Ea Addl Gest","code_information":[{"code":"3740050-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Xr Mandible Comp Min 4 Views","code_information":[{"code":"3700067-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Xr Orbits Comp Min 4 Views Bil","code_information":[{"code":"3700074-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Anterior Vitrectomy Pack ( Sightpath )","code_information":[{"code":"4300921","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300921","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Celero Biopsy Device (C)","code_information":[{"code":"4301008","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Falope Applicator Kit","code_information":[{"code":"4303614","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303614","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Miscellaneous Procedures ( Sightpath )","code_information":[{"code":"4300955","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300955","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Postpartum Balloon 24fr","code_information":[{"code":"4300204","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300204","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Surgical Mesh 3x5 Left","code_information":[{"code":"4300216","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300216","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Veraflo Cleanse Dressing Large","code_information":[{"code":"4300737","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300737","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Vitrectomy Pak 23ga","code_information":[{"code":"4300434","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300434","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"26750  Cltx Dstl Phlngl Fx Fngr/thmb W/o Man Ea","code_information":[{"code":"3332462","type":"CDM"},{"code":"521","type":"RC"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":307,"maximum":480,"gross_charge":500,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":475},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":307}]}]},{"description":"Rsv Vacc Pref A And Pref B/pfâ (Abrysvo)â Vaccine Charge","code_information":[{"code":"3332376","type":"CDM"},{"code":"636","type":"RC"},{"code":"90678","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306,"maximum":479,"gross_charge":499,"discounted_cash":449,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":479},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":306}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Armor Brace Md Left","code_information":[{"code":"4302410","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302410","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":305,"maximum":477,"gross_charge":497,"discounted_cash":447,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":477},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":305}]}]},{"description":"Serfas Energy 90-s Cruise (C)","code_information":[{"code":"4300183","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300183","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":303,"maximum":473,"gross_charge":493,"discounted_cash":444,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":303}]}]},{"description":"Tc99m Mebrofenin Per Vial (Choletec)","code_information":[{"code":"4068035","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":302,"maximum":472,"gross_charge":492,"discounted_cash":443,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":302}]}]},{"description":"Floseal 5ml","code_information":[{"code":"4301237","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301237","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":301,"maximum":471,"gross_charge":491,"discounted_cash":442,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":471},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":457},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":301}]}]},{"description":"Ligamax 5","code_information":[{"code":"4301606","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301606","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":301,"maximum":470,"gross_charge":490,"discounted_cash":441,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":301}]}]},{"description":"99213 Allergy Serum + Office Visit Level 3 Established","code_information":[{"code":"3331680","type":"CDM"},{"code":"521","type":"RC"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":301,"maximum":470,"gross_charge":490,"discounted_cash":441,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":470},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":301}]}]},{"description":"Cautery- Ent","code_information":[{"code":"4309028","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":300,"maximum":468,"gross_charge":488,"discounted_cash":439,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":454},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":300}]}]},{"description":"Im Plug Lg (C)","code_information":[{"code":"4309140","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309140","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":299,"maximum":468,"gross_charge":487,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":299}]}]},{"description":"Im Plug Med (C)","code_information":[{"code":"4309139","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309139","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":299,"maximum":468,"gross_charge":487,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":299}]}]},{"description":"Im Plug Sm (C)","code_information":[{"code":"4309138","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309138","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":299,"maximum":468,"gross_charge":487,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":299}]}]},{"description":"Disp. Kit For Teno Scrw","code_information":[{"code":"4301188","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301188","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":299,"maximum":468,"gross_charge":487,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":468},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":463},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":299}]}]},{"description":"Cold Knife, Straight Blade","code_information":[{"code":"4301154","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301154","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":298,"maximum":467,"gross_charge":486,"discounted_cash":437,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"Xr Facial Bones Comp Min 3 Views","code_information":[{"code":"3700040-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":298,"maximum":466,"gross_charge":485,"discounted_cash":437,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":466},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":298}]}]},{"description":"36593 Declot Thrombolytic Agt Impltd Vasc Device","code_information":[{"code":"3331971","type":"CDM"},{"code":"361","type":"RC"},{"code":"36593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":297,"maximum":465,"gross_charge":484,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":460},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":297}]}]},{"description":"Savary-gilliard Wire Guide","code_information":[{"code":"4304027","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":296,"maximum":464,"gross_charge":483,"discounted_cash":435,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":459},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":449},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":296}]}]},{"description":"Fibertape (White/black)  W/ Cutting Ndl (C)","code_information":[{"code":"4302073","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302073","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":295,"maximum":462,"gross_charge":481,"discounted_cash":433,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":457},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":295}]}]},{"description":"Fibertape (White/blue) W/cutting Ndl (C)","code_information":[{"code":"4302074","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302074","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":295,"maximum":462,"gross_charge":481,"discounted_cash":433,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":457},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":295}]}]},{"description":"90677 Pneumococcal 20-valent Vaccine","code_information":[{"code":"3331058","type":"CDM"},{"code":"636","type":"RC"},{"code":"90677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295,"maximum":462,"gross_charge":481,"discounted_cash":433,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":457},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":295}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"10061 Incision & Drainage Abscess Complicated/multiple","code_information":[{"code":"3331882","type":"CDM"},{"code":"361","type":"RC"},{"code":"10061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295,"maximum":461,"gross_charge":480,"discounted_cash":432,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":295}]}]},{"description":"Xr Ribs Min 3 Views Rt W/ Pa Chest","code_information":[{"code":"3700118-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":295,"maximum":461,"gross_charge":480,"discounted_cash":432,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":295}]}]},{"description":"Drill Bit 3.5 Coupling 110mm","code_information":[{"code":"4309120","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309120","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":295,"maximum":461,"gross_charge":480,"discounted_cash":432,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":295}]}]},{"description":"Oxygen, 12-24 Hrs Charge","code_information":[{"code":"3950024","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3950024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":456,"gross_charge":475,"discounted_cash":428,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"94645 Rt Continous Aerosol Subsequent Charge","code_information":[{"code":"3900086","type":"CDM"},{"code":"410","type":"RC"},{"code":"94645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":456,"gross_charge":475,"discounted_cash":428,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"94761 Continuous Pulse Ox Charge","code_information":[{"code":"4301225","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":456,"gross_charge":475,"discounted_cash":428,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"94799 Rt Ezpap/accupap Subsequent Charge","code_information":[{"code":"3900104-76","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT","modifier":"76"}],"standard_charges":[{"setting":"outpatient","modifier_code":["76"],"minimum":292,"maximum":456,"gross_charge":475,"discounted_cash":428,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Balloon Dilator 18-20 ( C )","code_information":[{"code":"4300255","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300255","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":456,"gross_charge":475,"discounted_cash":428,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Snap 150ml Cartridge","code_information":[{"code":"4300837","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300837","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":292,"maximum":456,"gross_charge":475,"discounted_cash":428,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":456},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":292}]}]},{"description":"Quikclip Pro 230cm (C)","code_information":[{"code":"4308911","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308911","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":289,"maximum":452,"gross_charge":471,"discounted_cash":424,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":289}]}]},{"description":"93922tc Ankle/arm Index","code_information":[{"code":"4020008-TC","type":"CDM"},{"code":"929","type":"RC"},{"code":"93922","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":288,"maximum":451,"gross_charge":470,"discounted_cash":423,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"13133 Repair Complex F/c/c/m/n/ax/g/h/f Ea Addl 5 Cm","code_information":[{"code":"3331903","type":"CDM"},{"code":"361","type":"RC"},{"code":"13133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":451,"gross_charge":470,"discounted_cash":423,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Xr Sinuses Paranasal Comp Min 3 Views","code_information":[{"code":"3700098-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":288,"maximum":451,"gross_charge":470,"discounted_cash":423,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"42809 Remove Pharynx Foreign Body.","code_information":[{"code":"3332420","type":"CDM"},{"code":"521","type":"RC"},{"code":"42809","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":451,"gross_charge":470,"discounted_cash":423,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":451},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":447},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Chest Drain- Pleurevac","code_information":[{"code":"4300482","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300482","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":288,"maximum":450,"gross_charge":469,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":288}]}]},{"description":"Micafungin 100 Mg Pow [Gmh]","code_information":[{"code":"4504013","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323072910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":288,"maximum":450,"gross_charge":469,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":291}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Alteplase 2 Mg Iv Inj [Gmh]","code_information":[{"code":"4500488","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":285,"maximum":445,"gross_charge":464,"discounted_cash":418,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":441},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":288}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Or Drill Bit 4.0mm 160mm","code_information":[{"code":"4301248","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301248","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":284,"maximum":444,"gross_charge":463,"discounted_cash":417,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":444},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":284}]}]},{"description":"94660 Cpap/bipap Vent Initiation Mgmt","code_information":[{"code":"3331964","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":282,"maximum":442,"gross_charge":460,"discounted_cash":414,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":282}]}]},{"description":"Bionic Knee Brace","code_information":[{"code":"4302485","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302485","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":282,"maximum":442,"gross_charge":460,"discounted_cash":414,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":282}]}]},{"description":"99212 Allergy Serum + Office Visit Level 2 Established","code_information":[{"code":"3331679","type":"CDM"},{"code":"521","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":282,"maximum":442,"gross_charge":460,"discounted_cash":414,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":442},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":282}]}]},{"description":"19281 Needle Localization","code_information":[{"code":"3720006","type":"CDM"},{"code":"360","type":"RC"},{"code":"19281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":281,"maximum":440,"gross_charge":458,"discounted_cash":412,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":281}]}]},{"description":"Biozip 5.0mm Fiber Wire","code_information":[{"code":"4308977","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308977","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":279,"maximum":437,"gross_charge":455,"discounted_cash":410,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":423},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":279}]}]},{"description":"Multipurpose Drainage Cath Set","code_information":[{"code":"4303062","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303062","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":279,"maximum":437,"gross_charge":455,"discounted_cash":410,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":437},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":423},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":279}]}]},{"description":"Nm Tc99 Technetium Medronate","code_information":[{"code":"4060050","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":278,"maximum":435,"gross_charge":453,"discounted_cash":408,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":421},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":278}]}]},{"description":"Laceration Repair Simple 2.5-30 Cmscalp/trunk/extremities","code_information":[{"code":"3333046","type":"CDM"},{"code":"450","type":"RC"},{"code":"12005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":277,"maximum":433,"gross_charge":451,"discounted_cash":406,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":277}]}]},{"description":"51705 Change Cystostomy Tube Smpl","code_information":[{"code":"3331972","type":"CDM"},{"code":"361","type":"RC"},{"code":"51705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Us Breast Bil.","code_information":[{"code":"3740006-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Us Echo Doppler Ltd","code_information":[{"code":"4040003-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"93321","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Xr Knee Comp Min 4 Views Lt","code_information":[{"code":"3700057-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Xr Pelvis Comp Min 3 Views","code_information":[{"code":"3700079-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"94644 Rt Continous Aerosol 1st Hour Charge","code_information":[{"code":"3900085","type":"CDM"},{"code":"410","type":"RC"},{"code":"94644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"94799 Rt Ezpap/accupap Charge","code_information":[{"code":"3900089","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Capsular Tension Ring ( Sightpath )","code_information":[{"code":"4300923","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300923","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Carpal Tunnel Knife ( Ref# On Pkg Is 080003)","code_information":[{"code":"4301298","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301298","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}]},{"description":"Puraplyam 1.6 Sq Cm Disc","code_information":[{"code":"4308105","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Puraplyam 2x2","code_information":[{"code":"4308106","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Puraplyam 2x4","code_information":[{"code":"4308107","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Puraplyam 5x5","code_information":[{"code":"4308108","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":276,"maximum":432,"gross_charge":450,"discounted_cash":405,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":432},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":276}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Rifampin 600 Mg Iv Inj [Gmh]","code_information":[{"code":"4500068","type":"CDM"},{"code":"250","type":"RC"},{"code":"00068059701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":276,"maximum":431,"gross_charge":449,"discounted_cash":404,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":278}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Drill Bit 2.5mm  110mm Gold","code_information":[{"code":"4309122","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309122","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":275,"maximum":430,"gross_charge":448,"discounted_cash":403,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":426},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":275}]}]},{"description":"Mammography, screening, bilateral","code_information":[{"code":"3720003-TC","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":270,"maximum":422,"gross_charge":440,"discounted_cash":396,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Mammography, screening, bilateral","code_information":[{"code":"3720004-TC","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":270,"maximum":422,"gross_charge":440,"discounted_cash":396,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Mammography, screening, bilateral","code_information":[{"code":"3720023-TC","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":270,"maximum":422,"gross_charge":440,"discounted_cash":396,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"Suture Cutter","code_information":[{"code":"4301121","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301121","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":422,"gross_charge":440,"discounted_cash":396,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":270}]}]},{"description":"10121 Ed Foreign Body Removal, Comp Charge","code_information":[{"code":"3333003","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":269,"maximum":420,"gross_charge":438,"discounted_cash":394,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":269}]}]},{"description":"4.5x14mm Corkscrew Ft","code_information":[{"code":"4301172","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301172","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":269,"maximum":420,"gross_charge":438,"discounted_cash":394,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":269}]}]},{"description":"Surgical Mesh 4x6  Left","code_information":[{"code":"4300242","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300242","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":269,"maximum":420,"gross_charge":438,"discounted_cash":394,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":269}]}]},{"description":"Surgical Mesh 4x6 Right","code_information":[{"code":"4300248","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300248","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":269,"maximum":420,"gross_charge":438,"discounted_cash":394,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":269}]}]},{"description":"Eptifibatide 20.  Soln [Gmh]","code_information":[{"code":"4503580","type":"CDM"},{"code":"250","type":"RC"},{"code":"00085117703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":268,"maximum":420,"gross_charge":437,"discounted_cash":393,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":420},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Troponin Roll Up82553 And 84484","code_information":[{"code":"28941285","type":"CDM"},{"code":"301","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":268,"maximum":419,"gross_charge":436,"discounted_cash":392,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":268}]}]},{"description":"Tlc75 Reload","code_information":[{"code":"4301708","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301708","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":267,"maximum":418,"gross_charge":435,"discounted_cash":392,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":418},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":405},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":267}]}]},{"description":"10080 Incision & Drainage Pilonidal Cyst Simple Techfee","code_information":[{"code":"3331883","type":"CDM"},{"code":"361","type":"RC"},{"code":"10080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":265,"maximum":414,"gross_charge":431,"discounted_cash":388,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":414},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":401},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":265}]}]},{"description":"Xr Spine Thoracic 2 Views","code_information":[{"code":"3700109-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":264,"maximum":413,"gross_charge":430,"discounted_cash":387,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"Balloon Dilator 16-18 (C)","code_information":[{"code":"4300251","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300251","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":413,"gross_charge":430,"discounted_cash":387,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"Smart Release Ectr","code_information":[{"code":"4304051","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":413,"gross_charge":430,"discounted_cash":387,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"Yag Laser Capsulotomy ( Sightpath )","code_information":[{"code":"4300935","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300935","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":264,"maximum":413,"gross_charge":430,"discounted_cash":387,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":413},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":409},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":264}]}]},{"description":"2.6 Fibertak Anchor Kit (C)","code_information":[{"code":"4301164","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301164","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":263,"maximum":412,"gross_charge":429,"discounted_cash":386,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":263}]}]},{"description":"Nm Myo Perf Wall Motion","code_information":[{"code":"4060060","type":"CDM"},{"code":"341","type":"RC"},{"code":"78478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":263,"maximum":411,"gross_charge":428,"discounted_cash":385,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":411},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":263}]}]},{"description":"Tc99m Sodium Pertechnetate","code_information":[{"code":"4060012","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":408,"gross_charge":425,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"96365 Ed Iv Infusion Initial Up To 1 Hour","code_information":[{"code":"4401114","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":408,"gross_charge":425,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Mammography of both breasts","code_information":[{"code":"3720001-TC","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":261,"maximum":408,"gross_charge":425,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Mammography of both breasts","code_information":[{"code":"3720024-TC","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":261,"maximum":408,"gross_charge":425,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Xr Knee 3 Views Lt","code_information":[{"code":"3700058-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":261,"maximum":408,"gross_charge":425,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"Endovive 20fr Peg Tray (C)","code_information":[{"code":"4301166","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301166","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":261,"maximum":408,"gross_charge":425,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":404},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":261}]}]},{"description":"99282fac Ed Level 2 Room Charge","code_information":[{"code":"3601202","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":406,"gross_charge":423,"discounted_cash":381,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Foot Drop Brace","code_information":[{"code":"4302453","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302453","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":406,"gross_charge":423,"discounted_cash":381,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":260}]}]},{"description":"Telemetry","code_information":[{"code":"4301820","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301820","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"10006 Fine Ndl Aspiration Biopsy, Us, Each Additional Lesion","code_information":[{"code":"3740026","type":"CDM"},{"code":"320","type":"RC"},{"code":"10006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (10mm) 212.101","code_information":[{"code":"4309800","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309800","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (12mm) 212.102","code_information":[{"code":"4309801","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309801","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (14mm) 212.103","code_information":[{"code":"4309802","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309802","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (16mm) 212.104","code_information":[{"code":"4309803","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309803","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (18mm) 212.105","code_information":[{"code":"4309804","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309804","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (20mm) 212.106","code_information":[{"code":"4309805","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309805","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (22mm) 212.107","code_information":[{"code":"4309806","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309806","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (24mm) 212.108","code_information":[{"code":"4309807","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309807","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (26mm) 212.109","code_information":[{"code":"4309808","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309808","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (28mm) 212.110","code_information":[{"code":"4309809","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309809","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (30mm) 212.111","code_information":[{"code":"4309810","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309810","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (32mm) 212.112","code_information":[{"code":"4309811","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309811","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (34mm) 212.113","code_information":[{"code":"4309812","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309812","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (35mm) 212.114","code_information":[{"code":"4309813","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309813","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (36mm) 212.115","code_information":[{"code":"4309814","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309814","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (38mm) 212.116","code_information":[{"code":"4309815","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309815","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (40mm) 212.117","code_information":[{"code":"4309816","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309816","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (42mm) 212.118","code_information":[{"code":"4309817","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309817","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (55mm) 212.119","code_information":[{"code":"4309818","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309818","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"3.5 Locking Self-tapping (48mm) 212.120","code_information":[{"code":"4309819","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309819","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Cataract- Lens Zcb00","code_information":[{"code":"4300351","type":"CDM"},{"code":"276","type":"RC"},{"code":"CP4300351","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Drill Bit 2.0mm/125mm/qc","code_information":[{"code":"4309121","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309121","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Endoclip Er320 (C)","code_information":[{"code":"4300924","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300924","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Tlc75 Linear Cutter","code_information":[{"code":"4301707","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301707","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":258,"maximum":403,"gross_charge":420,"discounted_cash":378,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":258}]}]},{"description":"Pneumothorax Set","code_information":[{"code":"4300484","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300484","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":257,"maximum":402,"gross_charge":419,"discounted_cash":377,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":257}]}]},{"description":"59030 Fetal Scalp Blood Sampling","code_information":[{"code":"3338021","type":"CDM"},{"code":"521","type":"RC"},{"code":"59030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":256,"maximum":400,"gross_charge":417,"discounted_cash":375,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":388},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":256}]}]},{"description":"28495 Closed Treatment Of Fracture Great Toe, Phalanx Or Phalanges; W/manipulation","code_information":[{"code":"3331755","type":"CDM"},{"code":"521","type":"RC"},{"code":"28495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":399,"gross_charge":416,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":399},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":395},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":387},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Xr Hand Min 3 Views Lt","code_information":[{"code":"3700048-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":255,"maximum":398,"gross_charge":415,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Xr Si Joints 1 Or 2 Views","code_information":[{"code":"3700104-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":255,"maximum":398,"gross_charge":415,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"Super 90-s","code_information":[{"code":"4305056","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305056","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":255,"maximum":398,"gross_charge":415,"discounted_cash":374,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":398},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":255}]}]},{"description":"10060 Ed I & D Abscess, Smpl Charge","code_information":[{"code":"3336001","type":"CDM"},{"code":"450","type":"RC"},{"code":"10060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":253,"maximum":396,"gross_charge":412,"discounted_cash":371,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":253}]}]},{"description":"Us Fetal Echo 2d Fol-up","code_information":[{"code":"3740072-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76826","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":253,"maximum":396,"gross_charge":412,"discounted_cash":371,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":391},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":253}]}]},{"description":"Holter Monitor Hook Up","code_information":[{"code":"4050015","type":"CDM"},{"code":"731","type":"RC"},{"code":"CP4050015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":252,"maximum":394,"gross_charge":410,"discounted_cash":369,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":252}]}]},{"description":"41100 Biopsy Of Tongue; Anterior Two-thirds (Gbmh)","code_information":[{"code":"3331993","type":"CDM"},{"code":"521","type":"RC"},{"code":"41100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":251,"maximum":393,"gross_charge":409,"discounted_cash":368,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":393},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":251}]}]},{"description":"Fetal Biophysical Profile W/o Non-stress Testing Charge","code_information":[{"code":"3334118-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76818","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":249,"maximum":390,"gross_charge":406,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"Capsule Retractors ( Sightpath )","code_information":[{"code":"4300925","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300925","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":249,"maximum":390,"gross_charge":406,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"Hernia Plug Lg","code_information":[{"code":"4309065","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309065","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":249,"maximum":390,"gross_charge":406,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"Sm Jnt S-tak Inst. Kit","code_information":[{"code":"4301174","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301174","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":249,"maximum":390,"gross_charge":406,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"40808biopsy, Vestibule Of Mouth","code_information":[{"code":"3331989","type":"CDM"},{"code":"521","type":"RC"},{"code":"40808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":249,"maximum":390,"gross_charge":406,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"96360ed Iv Infusion Hydration Initial Hour","code_information":[{"code":"3334136","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":249,"maximum":389,"gross_charge":405,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"99306 Initial Nh (H&p And High  Mdm)","code_information":[{"code":"3332272","type":"CDM"},{"code":"525","type":"RC"},{"code":"99306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":249,"maximum":389,"gross_charge":405,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"11106 Incisional Biopsy Of Skin (Eg, Wedge) (Including Simple Closure, When Performed); Single Lesio","code_information":[{"code":"3331344","type":"CDM"},{"code":"521","type":"RC"},{"code":"11106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":249,"maximum":389,"gross_charge":405,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":249}]}]},{"description":"12004 Repair Smpl Scalp/neck/ax/trunk And/or Extremities 7.6-12.5 Cm","code_information":[{"code":"3331892","type":"CDM"},{"code":"361","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":247,"maximum":387,"gross_charge":403,"discounted_cash":363,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":387},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":247}]}]},{"description":"Ureteral Stent 7 Fr","code_information":[{"code":"4300424","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300424","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":247,"maximum":386,"gross_charge":402,"discounted_cash":362,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":247}]}]},{"description":"Ureteral Stent 6fr","code_information":[{"code":"4301940","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301940","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":247,"maximum":386,"gross_charge":402,"discounted_cash":362,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":247}]}]},{"description":"Bupivacaine-meloxicam 200 Mg-6 Mg/7 Ml Ers [Gmh]","code_information":[{"code":"4507061","type":"CDM"},{"code":"250","type":"RC"},{"code":"47426050301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":246,"maximum":385,"gross_charge":401,"discounted_cash":361,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":249}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Event Monitor, Up To 30 Days","code_information":[{"code":"4050021","type":"CDM"},{"code":"731","type":"RC"},{"code":"93270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"12014 Simple Repair F/e/e/n/l/m 5.1cm-7.5 Cm Techfee","code_information":[{"code":"3331895","type":"CDM"},{"code":"361","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"27816 Cltx Trimalleolar Ankle Fx W/o Man","code_information":[{"code":"3331931","type":"CDM"},{"code":"361","type":"RC"},{"code":"27816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Bill Immunohisto Chemistry Stain Ihcgt","code_information":[{"code":"3803000","type":"CDM"},{"code":"306","type":"RC"},{"code":"88341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"96521 Application Of Cadd Pump Charge","code_information":[{"code":"4401135","type":"CDM"},{"code":"280","type":"RC"},{"code":"96521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"59025 Fetal Monitoring Charge","code_information":[{"code":"4301042","type":"CDM"},{"code":"720","type":"RC"},{"code":"59025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Gi Tube Care","code_information":[{"code":"3610530","type":"CDM"},{"code":"450","type":"RC"},{"code":"43752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"15271 Apply Skin Sub To Trunk, Arms, Legs; First 25 Sq Cm","code_information":[{"code":"3331812","type":"CDM"},{"code":"510","type":"RC"},{"code":"15271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"29581 Application Of  Multi-layer Compression System Lower Legrt","code_information":[{"code":"3331804","type":"CDM"},{"code":"510","type":"RC"},{"code":"29581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"29581 Application Of  Multi-layer Compression System Lower Leglt","code_information":[{"code":"3331803","type":"CDM"},{"code":"510","type":"RC"},{"code":"29581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"29581 Application Of  Multi-layer Compression System Lower Legbilateral","code_information":[{"code":"3331805","type":"CDM"},{"code":"510","type":"RC"},{"code":"29581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/or Mucous Membranes; 2.6","code_information":[{"code":"3333048","type":"CDM"},{"code":"450","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Mammography of one breast","code_information":[{"code":"3720005-TC","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Mammography of one breast","code_information":[{"code":"3720020-TC","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Xr Foot Comp Min 3 Views Lt","code_information":[{"code":"3700045-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Xr Hip Comp Min 2 Views Lt +Pelvis","code_information":[{"code":"3700050-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Xr Pelvis +Hip Infant Min 2 Views","code_information":[{"code":"3700081-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Xr Ribs 2 Views Lt","code_information":[{"code":"3700091-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Xr Spine Cerv 2 Or 3 Views","code_information":[{"code":"3700032-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Xr Spine Thoracolumbar 2 Views","code_information":[{"code":"3700120-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"94762 Rt Overnight Oximetry Charge","code_information":[{"code":"3900095","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Slp Speech Aac Eval First Hour Rehab Units","code_information":[{"code":"4250113-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92607","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Breast Pump Double (C)","code_information":[{"code":"4301129","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301129","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Tap For 2.7 Mm Cortex Screw 100 Mm","code_information":[{"code":"4309100","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Tap For 4 Mm Cancel Bonescrew","code_information":[{"code":"4309101","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309101","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"99306 Initial Nursing Facility – High (45 Min) Wound Care Charge","code_information":[{"code":"3331862","type":"CDM"},{"code":"525","type":"RC"},{"code":"99306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"46999 Unlisted Procedure, Anus (Gbmh)","code_information":[{"code":"3331753","type":"CDM"},{"code":"521","type":"RC"},{"code":"46999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":384,"gross_charge":400,"discounted_cash":360,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Influenza Virus Vaccine, Inactivated High-dose Preservative-free Trivalent Sus","code_information":[{"code":"4507149","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012565","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":245,"maximum":383,"gross_charge":399,"discounted_cash":359,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":247}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"12013 Repair Smpl F/e/e/n/l/m 2.6cm-5.0 Cm","code_information":[{"code":"3331894","type":"CDM"},{"code":"361","type":"RC"},{"code":"12013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245,"maximum":383,"gross_charge":399,"discounted_cash":359,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":245}]}]},{"description":"40800 Drainage Of Mouth Lesion","code_information":[{"code":"3332452","type":"CDM"},{"code":"521","type":"RC"},{"code":"40800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":244,"maximum":381,"gross_charge":397,"discounted_cash":357,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":381},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":244}]}]},{"description":"Nm Mugaultra Tag","code_information":[{"code":"4068050","type":"CDM"},{"code":"341","type":"RC"},{"code":"78990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":380,"gross_charge":396,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":243}]}]},{"description":"Nm Ultratag","code_information":[{"code":"4060061","type":"CDM"},{"code":"341","type":"RC"},{"code":"78890","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243,"maximum":380,"gross_charge":396,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":380},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":243}]}]},{"description":"Xr Chest 2 Views","code_information":[{"code":"3700021-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71046","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":242,"maximum":379,"gross_charge":395,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":242}]}]},{"description":"Cold Knife Half Moon","code_information":[{"code":"4301151","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301151","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":242,"maximum":379,"gross_charge":395,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":242}]}]},{"description":"40810 Excision Of Lesion Of Mucosa And Submucosa, Vestibule Of Mouth; Without Repair","code_information":[{"code":"3331877","type":"CDM"},{"code":"521","type":"RC"},{"code":"40810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":242,"maximum":379,"gross_charge":395,"discounted_cash":356,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":379},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":242}]}]},{"description":"Carter-thomason Close System (C)","code_information":[{"code":"4301180","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301180","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":242,"maximum":378,"gross_charge":394,"discounted_cash":355,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":242}]}]},{"description":"Heated Insufflation Tubing ( C )","code_information":[{"code":"4300866","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300866","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":242,"maximum":378,"gross_charge":394,"discounted_cash":355,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":242}]}]},{"description":"10008 Fine Ndl Aspiration Biopys, Fluroscopy, Each Additional Lesion","code_information":[{"code":"3740036","type":"CDM"},{"code":"320","type":"RC"},{"code":"10008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":241,"maximum":377,"gross_charge":393,"discounted_cash":354,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Adult Cpr-d Pads Aed","code_information":[{"code":"4300558","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300558","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":241,"maximum":376,"gross_charge":392,"discounted_cash":353,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Surefire Scorpion Needle (C)","code_information":[{"code":"4301070","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301070","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":241,"maximum":376,"gross_charge":392,"discounted_cash":353,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":376},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":241}]}]},{"description":"Hf Loop 24fr .35 Wire 12 Deg","code_information":[{"code":"4306015","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":240,"maximum":375,"gross_charge":391,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":375},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":240}]}]},{"description":"24650 Cltx Radial Head/neck Fx W/o Man","code_information":[{"code":"3331912","type":"CDM"},{"code":"361","type":"RC"},{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":374,"gross_charge":390,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Xr Femur 2 Views Bil","code_information":[{"code":"3700041-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":239,"maximum":374,"gross_charge":390,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Cataract- Z9000 Lens","code_information":[{"code":"4300380","type":"CDM"},{"code":"276","type":"RC"},{"code":"CP4300380","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":374,"gross_charge":390,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Linear Cutter Reload","code_information":[{"code":"4301665","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301665","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":374,"gross_charge":390,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Tecnis Preloaded Dcb00","code_information":[{"code":"4300386","type":"CDM"},{"code":"276","type":"RC"},{"code":"CP4300386","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":374,"gross_charge":390,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Tecnis Toric","code_information":[{"code":"4300330","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300330","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":374,"gross_charge":390,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Pain Buster Pump","code_information":[{"code":"4301162","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301162","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":239,"maximum":373,"gross_charge":389,"discounted_cash":350,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":373},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":239}]}]},{"description":"Probe Hook 3.5mm","code_information":[{"code":"4300181","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300181","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":372,"gross_charge":388,"discounted_cash":349,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":238}]}]},{"description":"12002 Repair Smpl Scalp/neck/ax/genit/trunk 2.6-7.5cm","code_information":[{"code":"3331891","type":"CDM"},{"code":"361","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":372,"gross_charge":387,"discounted_cash":348,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":238}]}]},{"description":"28510 Treatment Of Toe Fracture","code_information":[{"code":"3332418","type":"CDM"},{"code":"521","type":"RC"},{"code":"28510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":372,"gross_charge":387,"discounted_cash":348,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":372},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":238}]}]},{"description":"Xr Pelvis 1 Or 2 Views","code_information":[{"code":"3700078-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":236,"maximum":370,"gross_charge":385,"discounted_cash":347,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":236}]}]},{"description":"Custom Splint 5","code_information":[{"code":"4308891","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308891","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":236,"maximum":370,"gross_charge":385,"discounted_cash":347,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":236}]}]},{"description":"59200 Insertion Of Cervical Dilator","code_information":[{"code":"3338029","type":"CDM"},{"code":"59200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":236,"maximum":370,"gross_charge":385,"discounted_cash":347,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":370},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":236}]}]},{"description":"Abdomial ultrasound of pregnant uterus","code_information":[{"code":"3332220-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":235,"maximum":368,"gross_charge":383,"discounted_cash":345,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Needle Adult Io","code_information":[{"code":"4301142","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301142","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":235,"maximum":368,"gross_charge":383,"discounted_cash":345,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Needle Bariatric Io","code_information":[{"code":"4301143","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301143","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":235,"maximum":368,"gross_charge":383,"discounted_cash":345,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Needle Pediatric Io","code_information":[{"code":"4301144","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301144","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":235,"maximum":368,"gross_charge":383,"discounted_cash":345,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":235}]}]},{"description":"Desfluane 240ml Bottle [Gmh]","code_information":[{"code":"4500824","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019064134","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":367,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237}]}],"drug_information":{"unit":240,"type":"ML"}},{"description":"12011 Repair Smpl F/e/e/n/l/m 2.5cm/<","code_information":[{"code":"3331893","type":"CDM"},{"code":"361","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":234,"maximum":367,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":234}]}]},{"description":"28450 Cltx Tarsal Fx No Talus/calcaneous W/o Man","code_information":[{"code":"3331934","type":"CDM"},{"code":"361","type":"RC"},{"code":"28450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":234,"maximum":367,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":234}]}]},{"description":"Fibrillar 1 X 2 Surgicel Dressing","code_information":[{"code":"4301910","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301910","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":234,"maximum":367,"gross_charge":382,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":367},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":234}]}]},{"description":"Xr Chest Comp Min 4 Views","code_information":[{"code":"3700019-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71030","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":234,"maximum":366,"gross_charge":381,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":234}]}]},{"description":"Xr Ankle Comp Min 3 Views Lt","code_information":[{"code":"3700008-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":233,"maximum":365,"gross_charge":380,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":233}]}]},{"description":"Bone Cement Radiopaque","code_information":[{"code":"4300082","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300082","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":233,"maximum":365,"gross_charge":380,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":233}]}]},{"description":"Non-routine Bl Draw > 3 Yrs","code_information":[{"code":"3331216","type":"CDM"},{"code":"521","type":"RC"},{"code":"36410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":233,"maximum":364,"gross_charge":379,"discounted_cash":341,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":233}]}]},{"description":"Bone Prep Kit","code_information":[{"code":"4309626","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309626","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":232,"maximum":363,"gross_charge":378,"discounted_cash":340,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":232}]}]},{"description":"Traction Splint X-small","code_information":[{"code":"4301640","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301640","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":232,"maximum":363,"gross_charge":378,"discounted_cash":340,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":232}]}]},{"description":"Simple Repair Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 7.6 Cm To 12.5 Cm Charge","code_information":[{"code":"3333045","type":"CDM"},{"code":"450","type":"RC"},{"code":"12004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":231,"maximum":361,"gross_charge":376,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":231}]}]},{"description":"Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/or Mucous Membranes; 2.5","code_information":[{"code":"3333047","type":"CDM"},{"code":"450","type":"RC"},{"code":"12011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":231,"maximum":361,"gross_charge":376,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":361},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":231}]}]},{"description":"Ultra Tag Kit & Tc04","code_information":[{"code":"4060017","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":360,"gross_charge":375,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Bill Tissue Processing, Level Iv","code_information":[{"code":"3800804","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":360,"gross_charge":375,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Xr Elbow Comp Min 3 Views Bil","code_information":[{"code":"3700035-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":230,"maximum":360,"gross_charge":375,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Xr Nasal Bones Comp Min 3 Views","code_information":[{"code":"3700070-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":230,"maximum":360,"gross_charge":375,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Xr Sacrum +Coccyx Min 2 Views","code_information":[{"code":"3700093-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":230,"maximum":360,"gross_charge":375,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Xr Spine 1 View Specify Level","code_information":[{"code":"3700069-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":230,"maximum":360,"gross_charge":375,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Xr Sternum Min 2 Views","code_information":[{"code":"3700102-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":230,"maximum":360,"gross_charge":375,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Xr Wrist Comp Min 3 Views Rt","code_information":[{"code":"3700115-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":230,"maximum":360,"gross_charge":375,"discounted_cash":338,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":356},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":230}]}]},{"description":"Hydrocortisone/neomycin/polymyxin B Ophth 1%-0.35%-10000 Units/ml Susp [Gmh]","code_information":[{"code":"4501861","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064175","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":230,"maximum":359,"gross_charge":374,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":359},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":232}]}],"drug_information":{"unit":10000,"type":"UN"}},{"description":"Malyugin Ring 7.0mm","code_information":[{"code":"4300435","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300435","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":229,"maximum":358,"gross_charge":373,"discounted_cash":336,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":229}]}]},{"description":"Gemcitabine 200 Mg Pow [Gmh]","code_information":[{"code":"4500224","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002750101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":229,"maximum":358,"gross_charge":373,"discounted_cash":336,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":358},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":231}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Betamethasone Dipropionate Cream 0.05% (Augmented) 50 Gram, Tube [Gmh]","code_information":[{"code":"4500016","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168026550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":228,"maximum":357,"gross_charge":372,"discounted_cash":335,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":231}]}],"drug_information":{"unit":50,"type":"GR"}},{"description":"28515 Closed Treatment Of  Fracture, Phalanx Or Phalanges, Other Than Great Toe; W/manipulation, Eac","code_information":[{"code":"3331735","type":"CDM"},{"code":"521","type":"RC"},{"code":"28515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":228,"maximum":357,"gross_charge":372,"discounted_cash":335,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":357},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":228}]}]},{"description":"Us Therapeutic Amniotic Fluid Reduction","code_information":[{"code":"3740070-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"59001","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":227,"maximum":355,"gross_charge":370,"discounted_cash":333,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":227}]}]},{"description":"Xr Knee 1 Or 2 Views Lt","code_information":[{"code":"3700075-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":227,"maximum":355,"gross_charge":370,"discounted_cash":333,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":227}]}]},{"description":"Xr Skull < 4 Views","code_information":[{"code":"3700099-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":227,"maximum":355,"gross_charge":370,"discounted_cash":333,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":227}]}]},{"description":"Slp Sound Prod W/ Lang Comp Eval Rehab Units","code_information":[{"code":"4250106-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92523","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":227,"maximum":355,"gross_charge":370,"discounted_cash":333,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":227}]}]},{"description":"Proloop Mesh Medium","code_information":[{"code":"4300762","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300762","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":227,"maximum":355,"gross_charge":370,"discounted_cash":333,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":227}]}]},{"description":"Proloop Mesh Large","code_information":[{"code":"4300763","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300763","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":227,"maximum":355,"gross_charge":370,"discounted_cash":333,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":355},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":227}]}]},{"description":"Laceration Repair Simple 2.5-30 Cmface/eye/nose","code_information":[{"code":"3333049","type":"CDM"},{"code":"450","type":"RC"},{"code":"12014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":354,"gross_charge":369,"discounted_cash":332,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"94667 Chest Wall Precussion Manual Intital Charge","code_information":[{"code":"3900091","type":"CDM"},{"code":"410","type":"RC"},{"code":"94667","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":353,"gross_charge":368,"discounted_cash":331,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"94668 Chest Wall Precussion Manual Subsequent Charge","code_information":[{"code":"3900092","type":"CDM"},{"code":"410","type":"RC"},{"code":"94668","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":353,"gross_charge":368,"discounted_cash":331,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":353},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":226}]}]},{"description":"Linezolid 600 Mg Tab Ud [Gmh]","code_information":[{"code":"4507001","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877041920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":225,"maximum":352,"gross_charge":367,"discounted_cash":330,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"93005 Ekg 12 Lead Cp","code_information":[{"code":"4010002","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":350,"gross_charge":365,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":224}]}]},{"description":"Electrocardiogram","code_information":[{"code":"4010001","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":350,"gross_charge":365,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":224}]}]},{"description":"Nm Kinevac","code_information":[{"code":"4068045","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":350,"gross_charge":365,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":224}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Hme Vis For E&m Of New Pat,req:comp Hx,exam;med Dec Making Of High Complx;care Consist W Prob","code_information":[{"code":"3332017","type":"CDM"},{"code":"522","type":"RC"},{"code":"99345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224,"maximum":350,"gross_charge":365,"discounted_cash":329,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":224}]}]},{"description":"59050 Fetal Monitoring During Labor By Consulting Physician (Non-attending) With Written Report, Sup","code_information":[{"code":"4301045","type":"CDM"},{"code":"270","type":"RC"},{"code":"59050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":223,"maximum":349,"gross_charge":364,"discounted_cash":328,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Miloop Lens Fragmentation Device ( Sightpath )","code_information":[{"code":"4300951","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300951","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":223,"maximum":349,"gross_charge":364,"discounted_cash":328,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":223}]}]},{"description":"Cast Walking Heel","code_information":[{"code":"4300356","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300356","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":222,"maximum":348,"gross_charge":362,"discounted_cash":326,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":222}]}]},{"description":"Pentamidine 300 Mg Pow","code_information":[{"code":"4507136","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925052201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":347,"gross_charge":361,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":347},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"10021 Fine Needle Aspiration W/o Img Gdn Sngl Lesion","code_information":[{"code":"3331880","type":"CDM"},{"code":"361","type":"RC"},{"code":"10021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":346,"gross_charge":360,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Xr Abdomen 1 View","code_information":[{"code":"3700001-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":221,"maximum":346,"gross_charge":360,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Xr Humerus Min 2 Views Lt","code_information":[{"code":"3700053-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":221,"maximum":346,"gross_charge":360,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Xr Neck Soft Tissue","code_information":[{"code":"3700071-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":221,"maximum":346,"gross_charge":360,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"Pink Pigazzie Pad","code_information":[{"code":"4300270","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300270","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":346,"gross_charge":360,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"99492 First 70 Minutes In The First Initial Month Of Collaboration Care","code_information":[{"code":"3331950","type":"CDM"},{"code":"900","type":"RC"},{"code":"99492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":346,"gross_charge":360,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":221}]}]},{"description":"12001 Simple Repair Scalp/neck/ax/genit/trunk 2.5cm/< Techfee","code_information":[{"code":"3331890","type":"CDM"},{"code":"361","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":220,"maximum":345,"gross_charge":359,"discounted_cash":323,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":220}]}]},{"description":"Simple Repair  Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 2.6 Cm To 7.5 Cm Charge","code_information":[{"code":"3331556","type":"CDM"},{"code":"450","type":"RC"},{"code":"12002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":220,"maximum":345,"gross_charge":359,"discounted_cash":323,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":220}]}]},{"description":"Gemcitabine 2000 Mg Pow [Gmh]","code_information":[{"code":"4507019","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323012603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":220,"maximum":345,"gross_charge":359,"discounted_cash":323,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":345},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}],"drug_information":{"unit":2000,"type":"ME"}},{"description":"Xr Scapula Comp Lt","code_information":[{"code":"3700094-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":218,"maximum":341,"gross_charge":355,"discounted_cash":320,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":218}]}]},{"description":"Xr Tibia +Fibula 2 Views Bil","code_information":[{"code":"3700061-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":218,"maximum":341,"gross_charge":355,"discounted_cash":320,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":218}]}]},{"description":"Slp Pharyngeal Swallow Eval Rehab Units","code_information":[{"code":"4250110-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92610","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":218,"maximum":341,"gross_charge":355,"discounted_cash":320,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":341},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":218}]}]},{"description":"26600 Cltx Metacarpal Fx W/o Man Each Bone","code_information":[{"code":"3331918","type":"CDM"},{"code":"361","type":"RC"},{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":339,"gross_charge":353,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":217}]}]},{"description":"M0243 Regeneron Combo Infusion Charge","code_information":[{"code":"3332329","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":339,"gross_charge":353,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":217}]}]},{"description":"M0245 Bamlanivimab/etesevimab Combo Infusion Charge","code_information":[{"code":"3332342","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":339,"gross_charge":353,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":217}]}]},{"description":"M0247 Sotrovimab Infusion Charge","code_information":[{"code":"3332343","type":"CDM"},{"code":"771","type":"RC"},{"code":"M0247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":217,"maximum":339,"gross_charge":353,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":339},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":217}]}]},{"description":"Bard Mesh 3 X 6","code_information":[{"code":"4300809","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300809","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":338,"gross_charge":352,"discounted_cash":317,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":216}]}]},{"description":"Hf Roller 24-28fr 12/30 Deg","code_information":[{"code":"4306016","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":215,"maximum":337,"gross_charge":351,"discounted_cash":316,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"Spirometry","code_information":[{"code":"4000052","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":215,"maximum":336,"gross_charge":350,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"27760 Cltx Medial Malleolus Ankle Fx W/o Man","code_information":[{"code":"3331926","type":"CDM"},{"code":"361","type":"RC"},{"code":"27760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":215,"maximum":336,"gross_charge":350,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"96417 Chemo Iv Inf Ea Addl Up To 1 Hr Charge","code_information":[{"code":"4401124","type":"CDM"},{"code":"280","type":"RC"},{"code":"96417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":215,"maximum":336,"gross_charge":350,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"Slp Tx Generating Device Rehab Units","code_information":[{"code":"4250114-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92609","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":215,"maximum":336,"gross_charge":350,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"Malyugin Ring 6.25mm","code_information":[{"code":"4300436","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300436","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":215,"maximum":336,"gross_charge":350,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":336},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":333},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":215}]}]},{"description":"36680 Plcmnt Needle Intraosseous Inf","code_information":[{"code":"3331940","type":"CDM"},{"code":"361","type":"RC"},{"code":"36680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":335,"gross_charge":349,"discounted_cash":314,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"Etoposide 20 Mg/ml (1000mg) Sol [Gmh]","code_information":[{"code":"4507102","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323010450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":335,"gross_charge":349,"discounted_cash":314,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":216}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Universal Traction Boot","code_information":[{"code":"4301641","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301641","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":334,"gross_charge":348,"discounted_cash":313,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":214}]}]},{"description":"24670 Cltx Ulnar Shaft Fx Proximal End W/o Man","code_information":[{"code":"3331913","type":"CDM"},{"code":"361","type":"RC"},{"code":"24670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":332,"gross_charge":346,"discounted_cash":311,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"27750 Cltx Tibial Shaft Fx W/o Man","code_information":[{"code":"3331925","type":"CDM"},{"code":"361","type":"RC"},{"code":"27750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":331,"gross_charge":345,"discounted_cash":311,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"Xr Mastoids Comp Min 3 Views Bil","code_information":[{"code":"3700068-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70130","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":212,"maximum":331,"gross_charge":345,"discounted_cash":311,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":321},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":212}]}]},{"description":"95972 Elect Analys Neuro Pulse","code_information":[{"code":"3305250","type":"CDM"},{"code":"360","type":"RC"},{"code":"95972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":211,"maximum":330,"gross_charge":344,"discounted_cash":310,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":211}]}]},{"description":"Varicella Virus Vaccine Poc","code_information":[{"code":"3334208","type":"CDM"},{"code":"636","type":"RC"},{"code":"90716","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":211,"maximum":329,"gross_charge":343,"discounted_cash":309,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":329},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":211}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"26750 Cltx Dstl Phlngl Fx Fngr/thmb W/o Man","code_information":[{"code":"3331921","type":"CDM"},{"code":"361","type":"RC"},{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":328,"gross_charge":342,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":210}]}]},{"description":"Polyp Retrieval Basket","code_information":[{"code":"4300887","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300887","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":210,"maximum":328,"gross_charge":342,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":328},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":210}]}]},{"description":"Hydrocortisone/neomycin/polymyxin B Otic 1%-0.35%-10000 Units/ml Sus [Gmh]","code_information":[{"code":"4507082","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":209,"maximum":327,"gross_charge":341,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":211}]}],"drug_information":{"unit":10000,"type":"UN"}},{"description":"24500 Cltx Humeral Fx W/o Man","code_information":[{"code":"3331909","type":"CDM"},{"code":"361","type":"RC"},{"code":"24500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209,"maximum":327,"gross_charge":341,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":327},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"12021 Tx Superficial Wound Dehiscence W/packing","code_information":[{"code":"3331897","type":"CDM"},{"code":"360","type":"RC"},{"code":"12021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209,"maximum":326,"gross_charge":340,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"B-type Natriuretic Peptide","code_information":[{"code":"3800152","type":"CDM"},{"code":"301","type":"RC"},{"code":"83880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209,"maximum":326,"gross_charge":340,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"Ekg (Lab)","code_information":[{"code":"3840001","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209,"maximum":326,"gross_charge":340,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"Xr Chest Lordotic Only","code_information":[{"code":"3700117-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71021","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":209,"maximum":326,"gross_charge":340,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"Xr Clavicle Comp Lt","code_information":[{"code":"3700027-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":209,"maximum":326,"gross_charge":340,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"94010 Spirometry Charge","code_information":[{"code":"3900105","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209,"maximum":326,"gross_charge":340,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":209}]}]},{"description":"Mesalamine 4 G/60 Ml Ene [Gmh]","code_information":[{"code":"4507034","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802009851","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":209,"maximum":326,"gross_charge":340,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":211}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Diphtheria-tetanus Toxoids Pediatric Susp [Gmh]","code_information":[{"code":"4502737","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281022510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":206,"maximum":323,"gross_charge":336,"discounted_cash":302,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":208}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mst Single Use Instrument ( Sightpath )","code_information":[{"code":"4300952","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300952","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":206,"maximum":323,"gross_charge":336,"discounted_cash":302,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":323},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":319},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":206}]}]},{"description":"99493 First 60 Minutes In Subsequent Months Of Collaboration Care","code_information":[{"code":"3331951","type":"CDM"},{"code":"900","type":"RC"},{"code":"99493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":206,"maximum":322,"gross_charge":335,"discounted_cash":302,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":206}]}]},{"description":"59414 Deliver Placenta .","code_information":[{"code":"CP17805908878497036","type":"CDM"},{"code":"CP17805908878497036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":206,"maximum":322,"gross_charge":335,"discounted_cash":302,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":206}]}]},{"description":"Miochol E (Acetylcholine Chloride Intraocular Solution) [Gmh]","code_information":[{"code":"4501023","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208053920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":204,"maximum":320,"gross_charge":333,"discounted_cash":300,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Drill Bit 4.0 Mm 197 Mm","code_information":[{"code":"4309124","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309124","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":318,"gross_charge":331,"discounted_cash":298,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"54056 Cryosurgery Penis Lesion(s).","code_information":[{"code":"3332454","type":"CDM"},{"code":"521","type":"RC"},{"code":"54056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":318,"gross_charge":331,"discounted_cash":298,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"Xr Facial Bones < 3 Views","code_information":[{"code":"3700122-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70140","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":203,"maximum":317,"gross_charge":330,"discounted_cash":297,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"Xr Sinuses Paranasal < 3 Views","code_information":[{"code":"3700110-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":203,"maximum":317,"gross_charge":330,"discounted_cash":297,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"99310 Subsequent Nursing Facility – High (35 Min) Wound Care Charge","code_information":[{"code":"3331864","type":"CDM"},{"code":"525","type":"RC"},{"code":"99310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":203,"maximum":317,"gross_charge":330,"discounted_cash":297,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":314},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":203}]}]},{"description":"25500 Cltx Radial Shaft Fx W/o Man","code_information":[{"code":"3331914","type":"CDM"},{"code":"361","type":"RC"},{"code":"25500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":316,"gross_charge":329,"discounted_cash":296,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"27786 Cltx Dstl Fibular Fx Lat Mall W/o Man","code_information":[{"code":"3331929","type":"CDM"},{"code":"361","type":"RC"},{"code":"27786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":316,"gross_charge":329,"discounted_cash":296,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"27808 Cltx Bimalleolar Ankle Fx W/o Man","code_information":[{"code":"3331930","type":"CDM"},{"code":"361","type":"RC"},{"code":"27808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202,"maximum":316,"gross_charge":329,"discounted_cash":296,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":202}]}]},{"description":"Ertapenem 1 G Pow [Gmh]","code_information":[{"code":"4505046","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006384371","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":202,"maximum":316,"gross_charge":329,"discounted_cash":296,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":316},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":204}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Sevoflurane Inh Liq 250 Ml [Gmh]","code_information":[{"code":"4504100","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019065164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":200,"maximum":313,"gross_charge":326,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":202}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Pedi Aspen Collar (3-6 Years)","code_information":[{"code":"4308895","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308895","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":313,"gross_charge":326,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":200}]}]},{"description":"Shingrix Vaccine, 1 Dose Charge","code_information":[{"code":"3332428","type":"CDM"},{"code":"636","type":"RC"},{"code":"90750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":200,"maximum":313,"gross_charge":326,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":200}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cardiac Rehabilitation--phase Ii (Initial W/monitoring)","code_information":[{"code":"4000012","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":312,"gross_charge":325,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"96401 Chemo Im/subq Non-hormonal Charge","code_information":[{"code":"4401131","type":"CDM"},{"code":"280","type":"RC"},{"code":"96401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":312,"gross_charge":325,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"96401 Treatment Rm Inj Chemo Charge","code_information":[{"code":"3105080","type":"CDM"},{"code":"761","type":"RC"},{"code":"96401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":312,"gross_charge":325,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Xr Forearm 2 Views Lt","code_information":[{"code":"3700046-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":199,"maximum":312,"gross_charge":325,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"94640 Rt Aerosol Initial Charge","code_information":[{"code":"3900081","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":312,"gross_charge":325,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"94640 Rt Aerosol Subsequent Charge","code_information":[{"code":"3900082","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":312,"gross_charge":325,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"94640 Rt Metered Dose Inhaler Initial Charge","code_information":[{"code":"3900083","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":312,"gross_charge":325,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"94640 Rt Metered Dose Inhaler Subsequent Charge","code_information":[{"code":"3900084","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":312,"gross_charge":325,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":312},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":199}]}]},{"description":"Xr Chest 1 View","code_information":[{"code":"3700020-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":196,"maximum":307,"gross_charge":320,"discounted_cash":288,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"Bugbee Electrode 6 Fr","code_information":[{"code":"4308875","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308875","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":307,"gross_charge":320,"discounted_cash":288,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"Xr Ac Joints W/ Or W/o Weights Bil","code_information":[{"code":"3700010-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":196,"maximum":306,"gross_charge":319,"discounted_cash":287,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"3.5 Cortex Self-tap 12mm 204.812","code_information":[{"code":"4309840","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309840","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":306,"gross_charge":319,"discounted_cash":287,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"Alexis O Retractor Xlarge","code_information":[{"code":"4301113","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301113","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":196,"maximum":306,"gross_charge":319,"discounted_cash":287,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":196}]}]},{"description":"Repair Simple  Scalp, Neck, Axillae, Ext. Genital, Trunk And/or Extrem; 2.5 Cm > Charge","code_information":[{"code":"3331662","type":"CDM"},{"code":"450","type":"RC"},{"code":"12001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195,"maximum":304,"gross_charge":317,"discounted_cash":285,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":195}]}]},{"description":"28510 Cltx Fx Phlx/phlg Oth/thn Grt Toe W/o Man","code_information":[{"code":"3331937","type":"CDM"},{"code":"361","type":"RC"},{"code":"28510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":193,"maximum":302,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"G0379 Direct Admission Of Patient For Hospital Observation Care","code_information":[{"code":"3331876","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":193,"maximum":302,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"Ma Post Procedure Lt","code_information":[{"code":"3720021-TC","type":"CDM"},{"code":"401","type":"RC"},{"code":"CP3720021TC","type":"LOCAL","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":193,"maximum":302,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"Us Guide Amniocentesis","code_information":[{"code":"3740002-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"76946","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":193,"maximum":302,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"Xr Elbow 2 Views Lt","code_information":[{"code":"3700036-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":193,"maximum":302,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"Nebulizer","code_information":[{"code":"3900080","type":"CDM"},{"code":"761","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":193,"maximum":302,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"Slp Auditory Processing Tx Rehab Units","code_information":[{"code":"4250115-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":193,"maximum":302,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"99310 Nh Visit  (High Mdm)","code_information":[{"code":"3332274","type":"CDM"},{"code":"525","type":"RC"},{"code":"99310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":193,"maximum":302,"gross_charge":315,"discounted_cash":284,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/or Packing) Any Method","code_information":[{"code":"3333081","type":"CDM"},{"code":"450","type":"RC"},{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":193,"maximum":301,"gross_charge":314,"discounted_cash":283,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":301},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":193}]}]},{"description":"Shaving Of Lesion, Single Lesion, Trunk, Arms Or Legs; >2.0 Cm  Technical Charge","code_information":[{"code":"3333014","type":"CDM"},{"code":"11303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":300,"gross_charge":313,"discounted_cash":282,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"57800 Dilation Of Cervical Canal, Instrumental","code_information":[{"code":"3338005","type":"CDM"},{"code":"57800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":300,"gross_charge":313,"discounted_cash":282,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"55000 Puncture Aspiration Of Hydrocele, Tunica Vaginalis, W Or W/o Injection Of Medication","code_information":[{"code":"3331745","type":"CDM"},{"code":"521","type":"RC"},{"code":"55000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":300,"gross_charge":313,"discounted_cash":282,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"94375 Flow Volume Loop Charge","code_information":[{"code":"3900108","type":"CDM"},{"code":"460","type":"RC"},{"code":"94375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192,"maximum":300,"gross_charge":312,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":192}]}]},{"description":"96411 Chemo Iv Push; Ea Addl Drug Charge","code_information":[{"code":"4401134","type":"CDM"},{"code":"280","type":"RC"},{"code":"96411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":190,"maximum":298,"gross_charge":310,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Xr Eye Fb Bil","code_information":[{"code":"3700038-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70030","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":190,"maximum":298,"gross_charge":310,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Xr Hip 1 View Lt","code_information":[{"code":"3700056-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":190,"maximum":298,"gross_charge":310,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":190}]}]},{"description":"Carboplatin 10 Mg/ml 60 Ml Sol [Gmh]","code_information":[{"code":"4505006","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323017260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":190,"maximum":297,"gross_charge":309,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":297},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":192}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Us Fetal Biophys Profile W/ Non-stress","code_information":[{"code":"3740061-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76818","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":189,"maximum":296,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Us Nuchal Translucency","code_information":[{"code":"3740078-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76813","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":189,"maximum":296,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Nasal Jejunal 8fr Feeding Tube","code_information":[{"code":"4301737","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301737","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":296,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"Puraplyam 6x9","code_information":[{"code":"4308117","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":296,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":189}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Reposition Of Iol ( Sightpath )","code_information":[{"code":"4300927","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300927","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":296,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"92507 Treatment/speech/language 15min","code_information":[{"code":"4250115","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":189,"maximum":296,"gross_charge":308,"discounted_cash":277,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":296},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":189}]}]},{"description":"23500 Cltx Clavicular Fx W/o Man","code_information":[{"code":"3331908","type":"CDM"},{"code":"361","type":"RC"},{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":188,"maximum":295,"gross_charge":307,"discounted_cash":276,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"26720 Cltx Phlngl Fx Prox/middle Px/f/t W/o Man Ea","code_information":[{"code":"3331919","type":"CDM"},{"code":"361","type":"RC"},{"code":"26720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":188,"maximum":294,"gross_charge":306,"discounted_cash":275,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":188}]}]},{"description":"Nm Tc99 Disofenin","code_information":[{"code":"4060067","type":"CDM"},{"code":"636","type":"RC"},{"code":"A9510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":188,"maximum":294,"gross_charge":306,"discounted_cash":275,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":188}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Home Visit Level 4 New99344","code_information":[{"code":"3332016","type":"CDM"},{"code":"522","type":"RC"},{"code":"99344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":293,"gross_charge":305,"discounted_cash":275,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"25530 Cltx Ulnar Shaft Fx W/o Man","code_information":[{"code":"3331915","type":"CDM"},{"code":"361","type":"RC"},{"code":"25530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187,"maximum":292,"gross_charge":304,"discounted_cash":274,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":187}]}]},{"description":"Rhogam 300mcg Inj [Gmh]","code_information":[{"code":"4502425","type":"CDM"},{"code":"250","type":"RC"},{"code":"00562780505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":186,"maximum":291,"gross_charge":303,"discounted_cash":273,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":188}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Compatiblecrossmatch Ahg Interp","code_information":[{"code":"3800288","type":"CDM"},{"code":"302","type":"RC"},{"code":"86921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"4000010","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Thallium 201 Per Mci","code_information":[{"code":"4060016","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"96375ed Iv Injection, Add New Drug","code_information":[{"code":"4401129","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"96376ed Iv Injection, Add Same Drug","code_information":[{"code":"4401130","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"26740 Cltx Finger Fracture Incl Mp Or Pip Jt Wo Manip","code_information":[{"code":"3331920","type":"CDM"},{"code":"361","type":"RC"},{"code":"26740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"27767 Cltx Post Malleolus Ankle Fx W/o Man","code_information":[{"code":"3331927","type":"CDM"},{"code":"361","type":"RC"},{"code":"27767","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Abg 14","code_information":[{"code":"3800700","type":"CDM"},{"code":"301","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Acetaminophen Level","code_information":[{"code":"3806143","type":"CDM"},{"code":"301","type":"RC"},{"code":"80329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Arterial Cord Blood Gas Gbmh","code_information":[{"code":"3806082","type":"CDM"},{"code":"301","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Bill Immunohisto Chemistry Stain Ipxgt","code_information":[{"code":"3803001","type":"CDM"},{"code":"306","type":"RC"},{"code":"88342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Capillary Blood Gas.","code_information":[{"code":"3806107","type":"CDM"},{"code":"301","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Salicylate","code_information":[{"code":"3806142","type":"CDM"},{"code":"301","type":"RC"},{"code":"80329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Venous Blood Gas","code_information":[{"code":"3806106","type":"CDM"},{"code":"301","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Venous Cord Blood Gas Gbmh","code_information":[{"code":"3806083","type":"CDM"},{"code":"301","type":"RC"},{"code":"82803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"96367 Iv Infusion Add Seq Charge","code_information":[{"code":"4401126","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"0708t Intradermal Cancer Immunotherapy; Preparation And Initial Injection","code_information":[{"code":"4401136","type":"CDM"},{"code":"280","type":"RC"},{"code":"0708T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Ot Orthotic Mgmt/train Establish Rehab Units","code_information":[{"code":"4200116-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97763","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"15274 Apply Skin Sub To Trunk, Arms, Legs; Each Addl 100 Sq Cm","code_information":[{"code":"3331818","type":"CDM"},{"code":"510","type":"RC"},{"code":"15274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"15278 Apply Skin Sub To Head, Genitalia, Hands, Feet; Each Addl 100 Sq Cm","code_information":[{"code":"3331819","type":"CDM"},{"code":"510","type":"RC"},{"code":"15278","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"27230 Cltx Femoral Fx Proximal End/neck W/o Man","code_information":[{"code":"3331922","type":"CDM"},{"code":"361","type":"RC"},{"code":"27230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"96415 Chemo Adm, Iv Infus Ea Add Hr Charge","code_information":[{"code":"4401125","type":"CDM"},{"code":"280","type":"RC"},{"code":"96415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Foot 2 Views Lt","code_information":[{"code":"3700065-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Hand 2 Views Lt","code_information":[{"code":"3700051-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Mastoids < 3 Views Bil","code_information":[{"code":"3700123-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70120","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Optic Foramina Bil","code_information":[{"code":"3700125-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70190","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Sternoclavicular Joint(s) Min 3 Views","code_information":[{"code":"3700103-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"71130","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Xr Ue Infant Min 2 Views Lt","code_information":[{"code":"3700111-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"94761 Rt Pulse Oximetry Multipe Determination Charge","code_information":[{"code":"3900094","type":"CDM"},{"code":"460","type":"RC"},{"code":"94761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Aerosol Treatment","code_information":[{"code":"3332254","type":"CDM"},{"code":"761","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Slp Analysis Of Voice & Resonance Rehab Units","code_information":[{"code":"4250107-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92524","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Slp Assessment Of Aphasia Rehab Units","code_information":[{"code":"4250130-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"96105","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Bard Hernia Mesh 10 X 14","code_information":[{"code":"4300788","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300788","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Bone Cement Simplex ( C )","code_information":[{"code":"4300050","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300050","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Bugbee Blunt Tip 8fr","code_information":[{"code":"4308921","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308921","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Bugbee Dome Tip 6fr","code_information":[{"code":"4308974","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308974","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Burr Egg Diamond 4mm","code_information":[{"code":"4309132","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309132","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Knife Elect Ke-24","code_information":[{"code":"4308916","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308916","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Phillips Follower 24fr","code_information":[{"code":"4306723","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306723","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Phillips Follower 8fr","code_information":[{"code":"4306724","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306724","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Powerpicc 5fr Dual Lumen","code_information":[{"code":"4306004","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Puraply 3x4 Fen (C)","code_information":[{"code":"4308123","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Puraplyam 4.91 X 4.91 (C)","code_information":[{"code":"4308122","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Test Stim Kit","code_information":[{"code":"4301930","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301930","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Tx 60mm Linear Stapler","code_information":[{"code":"4301607","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301607","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"X-l Black Granufoam","code_information":[{"code":"4302006","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"90791 Psychiatric Diagnostic Evaluation (Intake, Enrollement)","code_information":[{"code":"3331953","type":"CDM"},{"code":"900","type":"RC"},{"code":"90791","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Psychotherapy, 60 min","code_information":[{"code":"3331954","type":"CDM"},{"code":"900","type":"RC"},{"code":"90837","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Psychotherapy, 60 min","code_information":[{"code":"3331949-95","type":"CDM"},{"code":"900","type":"RC"},{"code":"90837","type":"CPT","modifier":"95"}],"standard_charges":[{"setting":"outpatient","modifier_code":["95"],"minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"99305 Initial Nursing Facility – Moderate (35 Min) Wound Care Charge","code_information":[{"code":"3331860","type":"CDM"},{"code":"525","type":"RC"},{"code":"99305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"Aloh/diphenhyd/lidocaine/mgoh/simeth Topical 3.15 G-0.2 G-1.6 G-3.15 G-0.315 G/237 Ml Sus [Gmh]","code_information":[{"code":"4506092","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628005001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":184,"maximum":288,"gross_charge":300,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":186}]}],"drug_information":{"unit":315,"type":"GR"}},{"description":"Net Retriever Basket (Olympus) ( C)","code_information":[{"code":"4300878","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300878","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":184,"maximum":287,"gross_charge":299,"discounted_cash":269,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":287},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":184}]}]},{"description":"24576 Cltx Humeral Condylar Fx Medial/lat W/o Man","code_information":[{"code":"3331911","type":"CDM"},{"code":"361","type":"RC"},{"code":"24576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":286,"gross_charge":298,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"Stryker Togas (C)","code_information":[{"code":"4301255","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301255","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":183,"maximum":286,"gross_charge":298,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":183}]}]},{"description":"25622 Cltx Carpal Navicular Fx W/o Man","code_information":[{"code":"3331917","type":"CDM"},{"code":"361","type":"RC"},{"code":"25622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":285,"gross_charge":297,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":285},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Recover Knee Brace Short Airmesh Small","code_information":[{"code":"4302429","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302429","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":284,"gross_charge":296,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"29405 Application Of Short Leg Cast  (Below Knee To Toes)","code_information":[{"code":"3331731","type":"CDM"},{"code":"521","type":"RC"},{"code":"29405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182,"maximum":284,"gross_charge":296,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":182}]}]},{"description":"Oxacillin 10 G Pow [Gmh]","code_information":[{"code":"4507116","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":182,"maximum":284,"gross_charge":296,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":284},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":184}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Xr Heel Min 2 Views Lt","code_information":[{"code":"3700049-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":181,"maximum":283,"gross_charge":295,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":181}]}]},{"description":"Tcc-ez 3 Casting System","code_information":[{"code":"4300812","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300812","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":181,"maximum":283,"gross_charge":295,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":280},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":181}]}]},{"description":"Fibertape Suture","code_information":[{"code":"4302069","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302069","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":282,"gross_charge":294,"discounted_cash":265,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Brace, Hinged Knee(reg.)","code_information":[{"code":"4308985","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308985","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":281,"gross_charge":293,"discounted_cash":264,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Readywrap Thigh Med","code_information":[{"code":"4302033","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":281,"gross_charge":293,"discounted_cash":264,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Readywrap Thigh Small","code_information":[{"code":"4302035","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302035","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":281,"gross_charge":293,"discounted_cash":264,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":180}]}]},{"description":"Puraplyam 4x4","code_information":[{"code":"4308120","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":180,"maximum":281,"gross_charge":293,"discounted_cash":264,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":180}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Pelvic Belt","code_information":[{"code":"4302371","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302371","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":279,"gross_charge":291,"discounted_cash":262,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Speaking Valve Pmv2001","code_information":[{"code":"4302510","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302510","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":279,"gross_charge":291,"discounted_cash":262,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Tracheostomy Tube #6.5","code_information":[{"code":"4301866","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301866","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":279,"gross_charge":291,"discounted_cash":262,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Tracheostomy Tube #10","code_information":[{"code":"4301873","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301873","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":279,"gross_charge":291,"discounted_cash":262,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":179}]}]},{"description":"Bexsero Vaccine Charge","code_information":[{"code":"1110136013","type":"CDM"},{"code":"636","type":"RC"},{"code":"90620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179,"maximum":279,"gross_charge":291,"discounted_cash":262,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":179}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"96402 Chemo Injection; Hormonal Charge","code_information":[{"code":"4401132","type":"CDM"},{"code":"280","type":"RC"},{"code":"96402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":278,"gross_charge":290,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Xr Ankle 2 Views Bil","code_information":[{"code":"3700011-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":178,"maximum":278,"gross_charge":290,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Xr Shoulder 1 View Lt","code_information":[{"code":"3700121-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":178,"maximum":278,"gross_charge":290,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Xr Wrist 2 Views Rt","code_information":[{"code":"3700116-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":178,"maximum":278,"gross_charge":290,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Multipurpose Drain 8.5fr","code_information":[{"code":"4303059","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303059","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":278,"gross_charge":290,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Cardiovas Stress Test Using Maximal/submaximal Treadmill Or Bike Exercise, Cont.electrocardiographic","code_information":[{"code":"3332251","type":"CDM"},{"code":"482","type":"RC"},{"code":"93015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":178,"maximum":278,"gross_charge":290,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":278},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":178}]}]},{"description":"Vinorelbine 10 Mg/ml Sol 5 Ml [Gmh]","code_information":[{"code":"CP17805909631725393","type":"CDM"},{"code":"250","type":"RC"},{"code":"00173065644","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":177,"maximum":277,"gross_charge":289,"discounted_cash":260,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":277},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":179}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Magnesium Sulfate/potassium Sulfate/sodium Sulfate 1.6 G-3.13 G-17.5 G/177 Ml Liq [Gmh]","code_information":[{"code":"4506037","type":"CDM"},{"code":"250","type":"RC"},{"code":"52268001201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":176,"maximum":275,"gross_charge":286,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":177}]}],"drug_information":{"unit":16,"type":"GR"}},{"description":"High Sensitivity Troponin","code_information":[{"code":"3806127","type":"CDM"},{"code":"301","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":175,"maximum":274,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":175}]}]},{"description":"Troponin I","code_information":[{"code":"3800611","type":"CDM"},{"code":"301","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":175,"maximum":274,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":175}]}]},{"description":"2.7 Cortex Self-tap 14mm 202.814","code_information":[{"code":"4309822","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309822","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":175,"maximum":274,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":175}]}]},{"description":"2.7 Cortex Self-tap 18mm 202.818","code_information":[{"code":"4309824","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309824","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":175,"maximum":274,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":175}]}]},{"description":"2.7 Cortex Self-tap 22mm 202.822","code_information":[{"code":"4309826","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309826","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":175,"maximum":274,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":175}]}]},{"description":"99494 Each Additional 30 Mintues In A Month","code_information":[{"code":"3331952","type":"CDM"},{"code":"900","type":"RC"},{"code":"99494","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":175,"maximum":274,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":175}]}]},{"description":"Alpigraf","code_information":[{"code":"4308104","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":175,"maximum":274,"gross_charge":285,"discounted_cash":257,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":175}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nushield 2.5 X 2.5","code_information":[{"code":"4308121","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":273,"gross_charge":284,"discounted_cash":256,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":273},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":174}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Aprepitant 40 Mg Cap Ud [Gmh]","code_information":[{"code":"4505028","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006046410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":174,"maximum":272,"gross_charge":283,"discounted_cash":255,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":175}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"28470 Cltx Metatarsal Fracture W/o Man","code_information":[{"code":"3331935","type":"CDM"},{"code":"361","type":"RC"},{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":272,"gross_charge":283,"discounted_cash":255,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Ob- Breast Pump","code_information":[{"code":"4301024","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":272,"gross_charge":283,"discounted_cash":255,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Trocar Taut 8mm","code_information":[{"code":"4301935","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301935","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":272,"gross_charge":283,"discounted_cash":255,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"10021 Fine Needle Aspiration Biopsy, Without Imaging Guidance; First Lesion","code_information":[{"code":"3332400","type":"CDM"},{"code":"521","type":"RC"},{"code":"10021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174,"maximum":272,"gross_charge":283,"discounted_cash":255,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":263},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":174}]}]},{"description":"Ureteral Stent 4.5fr","code_information":[{"code":"4306720","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306720","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":271,"gross_charge":282,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"11104 Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion","code_information":[{"code":"3331341","type":"CDM"},{"code":"521","type":"RC"},{"code":"11104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":173,"maximum":271,"gross_charge":282,"discounted_cash":254,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":173}]}]},{"description":"Xr Tmj Open +Closed Bil","code_information":[{"code":"3700124-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70330","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":172,"maximum":270,"gross_charge":281,"discounted_cash":253,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"96374 Iv Push Initial Charge","code_information":[{"code":"4401128","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":269,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Xr Bone Age Studies","code_information":[{"code":"3700101-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":172,"maximum":269,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Xr Fingers Min 2 Views Lt","code_information":[{"code":"3700044-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":172,"maximum":269,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Pulmonary Rehab, First Session","code_information":[{"code":"4000040","type":"CDM"},{"code":"948","type":"RC"},{"code":"94625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172,"maximum":269,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Slp Swallow Dysfunction Oral Feed Rehab Units","code_information":[{"code":"4250120-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":172,"maximum":269,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"92507 Telemedicine Tx Of Speech, Language, Voice, Communication, Auditory","code_information":[{"code":"4250127-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":172,"maximum":269,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"92526 Telemedicine Tx Of Swallowing Dysfunction And/or Oral Function For Feeding","code_information":[{"code":"4250126-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":172,"maximum":269,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":172}]}]},{"description":"Fluticasone Nasal 0.05 Mg/inh Spry 16 Gm [Gmh]","code_information":[{"code":"4501129","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054327099","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":172,"maximum":269,"gross_charge":280,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":174}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"31720 Rt Suction (Nt And Tach)","code_information":[{"code":"3900102","type":"CDM"},{"code":"410","type":"RC"},{"code":"31720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171,"maximum":268,"gross_charge":279,"discounted_cash":251,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":171}]}]},{"description":"51703 Insert Foley/inswelling Cath Bldr Complicated","code_information":[{"code":"3331943","type":"CDM"},{"code":"361","type":"RC"},{"code":"51703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":265,"gross_charge":276,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Trocar Taut 10mm","code_information":[{"code":"4301932","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301932","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":265,"gross_charge":276,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Trocar Taut 5mm","code_information":[{"code":"4301934","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301934","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":265,"gross_charge":276,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Tru-pull Brace Lt Lg","code_information":[{"code":"4302437","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302437","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":265,"gross_charge":276,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Cosyntropin 0.25 Mg Powder-inj [Gmh]","code_information":[{"code":"4504002","type":"CDM"},{"code":"250","type":"RC"},{"code":"00548590000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":169,"maximum":265,"gross_charge":276,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":171}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"96366 Ed Infusion Add Hr","code_information":[{"code":"4401115","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":264,"gross_charge":275,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Isolation Fee Charge","code_information":[{"code":"4300865","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300865","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":169,"maximum":264,"gross_charge":275,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Xr Le Infant Min 2 Views Lt","code_information":[{"code":"3700060-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":169,"maximum":264,"gross_charge":275,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Xr Toe(s) Min 2 Views Lt","code_information":[{"code":"3700106-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":169,"maximum":264,"gross_charge":275,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Slp Sound Production Eval Units","code_information":[{"code":"4250119-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92522","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":169,"maximum":264,"gross_charge":275,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":169}]}]},{"description":"Insulin Lispro 100 Units/ml 3 Ml Subq Inj [Gmh]","code_information":[{"code":"4501377","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002879959","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":169,"maximum":264,"gross_charge":275,"discounted_cash":248,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":171}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Multihance 20 Ml Soln [Gmh]","code_information":[{"code":"4507225","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270516415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":167,"maximum":261,"gross_charge":272,"discounted_cash":245,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":258},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":169}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Poly Midline Cath 4fr Single Lumen","code_information":[{"code":"4300748","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300748","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":260,"gross_charge":271,"discounted_cash":244,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Procalcitonin","code_information":[{"code":"3806140","type":"CDM"},{"code":"301","type":"RC"},{"code":"84145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":259,"gross_charge":270,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Bd Dexa Appendicular Skeleton","code_information":[{"code":"1180002-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"77081","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":166,"maximum":259,"gross_charge":270,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Xr Mandible Partial < 4 Views","code_information":[{"code":"3700066-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70100","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":166,"maximum":259,"gross_charge":270,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Dermabond Prineo ( C )","code_information":[{"code":"4301751","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301751","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":166,"maximum":259,"gross_charge":270,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":257},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":166}]}]},{"description":"Acm Kit W/ Femoral Breakaway ( C )","code_information":[{"code":"4300086","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300086","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":256,"gross_charge":267,"discounted_cash":240,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":164}]}]},{"description":"Sully Shoulder Brace Lg","code_information":[{"code":"4302436","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302436","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":164,"maximum":256,"gross_charge":267,"discounted_cash":240,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":164}]}]},{"description":"29105 Ed Application Long Arm Splint Charge","code_information":[{"code":"3333076","type":"CDM"},{"code":"450","type":"RC"},{"code":"29105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":253,"gross_charge":264,"discounted_cash":238,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Burr Round Fluted 5.0mm","code_information":[{"code":"4309131","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309131","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":162,"maximum":253,"gross_charge":264,"discounted_cash":238,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":162}]}]},{"description":"Nicardipine 20 Mg/200 Ml-nacl 0.86% Sol [Gmh]","code_information":[{"code":"4507118","type":"CDM"},{"code":"250","type":"RC"},{"code":"43066000910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":162,"maximum":253,"gross_charge":264,"discounted_cash":238,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":253},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":164}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Bupropion 150 Mg/24 Hours Er Tab [Gmh]","code_information":[{"code":"4503084","type":"CDM"},{"code":"250","type":"RC"},{"code":"00187073030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":161,"maximum":252,"gross_charge":263,"discounted_cash":237,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":163}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Iohexol 350 Mg/ml Sol [Gmh]","code_information":[{"code":"4507226","type":"CDM"},{"code":"250","type":"RC"},{"code":"00407141491","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":161,"maximum":252,"gross_charge":262,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":162}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Alexis O Retractor Lg","code_information":[{"code":"4301112","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301112","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":161,"maximum":252,"gross_charge":262,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":161}]}]},{"description":"2.7 Cortex Self-tap 55mm 202.855","code_information":[{"code":"4309838","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309838","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":251,"gross_charge":261,"discounted_cash":235,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":251},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Pt Evaluation High Complexity Units","code_information":[{"code":"4200148-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Xr Knee Standing Ap Bil","code_information":[{"code":"3700059-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Aspen Adult Collar ( C )","code_information":[{"code":"4308897","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308897","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Breg Polar Care Cube ( C )","code_information":[{"code":"4300660","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300660","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Bss Solution Bottle 500ml","code_information":[{"code":"4300362","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300362","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Bugbee Electrode 5fr","code_information":[{"code":"4308920","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308920","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Burr Round Fluted 2.5mm","code_information":[{"code":"4309129","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309129","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Celero Site Marker (C)","code_information":[{"code":"4301009","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Laborie Ndl 35cm","code_information":[{"code":"4300703","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300703","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Lap Handgrip (C)","code_information":[{"code":"4308991","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308991","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Pedi Aspen Collar (1-3 Years)","code_information":[{"code":"4308896","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308896","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Pleurx Drain Kit","code_information":[{"code":"4303051","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Slyke Wound Adhesive 24cm (C)","code_information":[{"code":"4301955","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301955","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Tcc-ez X-l Cast","code_information":[{"code":"4300821","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300821","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"Thoracentesis Tray (O.r.)","code_information":[{"code":"4303060","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":160,"maximum":250,"gross_charge":260,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":160}]}]},{"description":"54050 Destruction Of Lesion(s) On The Penis, Simple; Chemical","code_information":[{"code":"3331879","type":"CDM"},{"code":"521","type":"RC"},{"code":"54050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":247,"gross_charge":257,"discounted_cash":231,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":158}]}]},{"description":"C-section Pack ( C )","code_information":[{"code":"4301032","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301032","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":246,"gross_charge":256,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Ultraclip Dual Trigger Breast Tissue Marker","code_information":[{"code":"4301097","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301097","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":246,"gross_charge":256,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"28490 Cltx Grt Toe Phlx/phlg Fx W/o Man","code_information":[{"code":"3331936","type":"CDM"},{"code":"361","type":"RC"},{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":245,"gross_charge":255,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"29515 Ed Application Short Leg Splint","code_information":[{"code":"3333080","type":"CDM"},{"code":"450","type":"RC"},{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":245,"gross_charge":255,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Pulmonary Rehab, Phase Ii","code_information":[{"code":"4000042","type":"CDM"},{"code":"948","type":"RC"},{"code":"94625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":245,"gross_charge":255,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Cement Mixing Bowl","code_information":[{"code":"4300087","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300087","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":245,"gross_charge":255,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Monofocal Iols J&j Eyhance ( Sightpath )","code_information":[{"code":"4300963","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300963","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":157,"maximum":245,"gross_charge":255,"discounted_cash":230,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":157}]}]},{"description":"Tetanus/diphth/pertuss (Tdap) Adult/adol 5 Units-2.5 Units-18.5 Mcg/0.5 Ml Sus","code_information":[{"code":"4505099","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":156,"maximum":244,"gross_charge":254,"discounted_cash":229,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":157}]}],"drug_information":{"unit":5,"type":"UN"}},{"description":"27780 Cltx Prox Fibula/shft Fx W/o Man","code_information":[{"code":"3331928","type":"CDM"},{"code":"361","type":"RC"},{"code":"27780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":242,"gross_charge":252,"discounted_cash":227,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":155}]}]},{"description":"Ropivacaine 0.2% (400mg/200ml)  Sol [Gmh]","code_information":[{"code":"4507145","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121173309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":155,"maximum":242,"gross_charge":252,"discounted_cash":227,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":156}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Vapor Clean Filters","code_information":[{"code":"4306034","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306034","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":241,"gross_charge":251,"discounted_cash":226,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":154}]}]},{"description":"Medroxyprogesterone 150.  Susp [Gmh]","code_information":[{"code":"4503007","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993037179","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":153,"maximum":240,"gross_charge":250,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"96361 Ed Iv Hydration 31 Min To Hr Ea Addtl Hour List Separately In Addt To Code For Primary Procedu","code_information":[{"code":"3334120","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":240,"gross_charge":250,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Us Bladder +Residual Post Voiding","code_information":[{"code":"3740011-TC","type":"CDM"},{"code":"402","type":"RC"},{"code":"51798","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":153,"maximum":240,"gross_charge":250,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Slp Speech Fluency Eval Rehab Units","code_information":[{"code":"4250105-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"92521","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":153,"maximum":240,"gross_charge":250,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Antimicrobial Ear Tube","code_information":[{"code":"4305525","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305525","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":240,"gross_charge":250,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Dissector 5mm Curved","code_information":[{"code":"4301912","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301912","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":240,"gross_charge":250,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Paracentesis Proc Tray","code_information":[{"code":"4303016","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":240,"gross_charge":250,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Psychotherapy, 45 min","code_information":[{"code":"3331955","type":"CDM"},{"code":"900","type":"RC"},{"code":"90834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":153,"maximum":240,"gross_charge":250,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Us Doppler Middle Cerebral Art","code_information":[{"code":"3740076-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76821","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":153,"maximum":239,"gross_charge":249,"discounted_cash":224,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":153}]}]},{"description":"Tcc-ez Lg Cast","code_information":[{"code":"4300814","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300814","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":152,"maximum":238,"gross_charge":248,"discounted_cash":223,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":152}]}]},{"description":"Alcohol Level 1","code_information":[{"code":"3800030","type":"CDM"},{"code":"301","type":"RC"},{"code":"80320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":235,"gross_charge":245,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Echelon Reloads","code_information":[{"code":"4301622","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301622","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":235,"gross_charge":245,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Pamidronate 9 Mg/ml Sol 10 Ml [Gmh]","code_information":[{"code":"4503005","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457044610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":150,"maximum":235,"gross_charge":245,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":152}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"2.7 Cortex Self-tap 12mm 202.812","code_information":[{"code":"4309821","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309821","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":234,"gross_charge":244,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"2.7 Cortex Self-tap 28mm 202.828","code_information":[{"code":"4309829","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309829","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":234,"gross_charge":244,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"2.7 Cortex Self-tap 30mm 202.830","code_information":[{"code":"4309830","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309830","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":234,"gross_charge":244,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"2.7 Cortex Self-tap 34mm 202.834","code_information":[{"code":"4309832","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309832","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":234,"gross_charge":244,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Gastrostomy Tube 24 Fr","code_information":[{"code":"4300738","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300738","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":234,"gross_charge":244,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Pannus Retention System (C)","code_information":[{"code":"4302173","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302173","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":234,"gross_charge":244,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"Sylke Wound Adhesive (C)","code_information":[{"code":"4301965","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301965","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":234,"gross_charge":244,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":150}]}]},{"description":"3.5 Cortex Self-tap 14mm 204.814","code_information":[{"code":"4309841","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309841","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":233,"gross_charge":243,"discounted_cash":219,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"3.5 Cortex Self-tap 16mm 204.816","code_information":[{"code":"4309842","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309842","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":233,"gross_charge":243,"discounted_cash":219,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"3.5 Cortex Self-tap18mm 204.818","code_information":[{"code":"4309843","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309843","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":233,"gross_charge":243,"discounted_cash":219,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"3.5 Cortex Self-tap 50mm 204.850","code_information":[{"code":"4309856","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309856","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":233,"gross_charge":243,"discounted_cash":219,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"3.5 Cortex Self-tap 55mm 204.855","code_information":[{"code":"4309857","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309857","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":233,"gross_charge":243,"discounted_cash":219,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"29125 Ed Application Short Arm Splint","code_information":[{"code":"3333077","type":"CDM"},{"code":"450","type":"RC"},{"code":"29125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":149,"maximum":232,"gross_charge":242,"discounted_cash":218,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":232},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":149}]}]},{"description":"4.0 Cancellous Full Thd 10mm 206.010","code_information":[{"code":"4309871","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309871","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 12mm 206.012","code_information":[{"code":"4309872","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309872","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 14mm 206.014","code_information":[{"code":"4309873","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309873","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 16mm 206.016","code_information":[{"code":"4309874","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309874","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 18mm 206.018","code_information":[{"code":"4309875","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309875","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 20mm 206.020","code_information":[{"code":"4309876","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309876","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 24mm 206.024","code_information":[{"code":"4309878","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309878","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 26mm 206.026","code_information":[{"code":"4309879","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309879","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 28mm 206.028","code_information":[{"code":"4309880","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309880","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 30mm 206.030","code_information":[{"code":"4309881","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309881","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 35mm 206.035","code_information":[{"code":"4309882","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309882","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 40mm 206.040","code_information":[{"code":"4309883","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309883","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 45mm 206.045","code_information":[{"code":"4309884","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309884","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 50mm 206.050","code_information":[{"code":"4309885","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309885","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"4.0 Cancellous Full Thd 55mm 206.055","code_information":[{"code":"4309886","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309886","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"Miami J Collar","code_information":[{"code":"4308914","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308914","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":148,"maximum":231,"gross_charge":241,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":148}]}]},{"description":"24560 Cltx Humeral Epicond Fx W/o Man","code_information":[{"code":"3331910","type":"CDM"},{"code":"361","type":"RC"},{"code":"24560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":230,"gross_charge":240,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"28430 Cltx Talus Fx W/o Man","code_information":[{"code":"3331933","type":"CDM"},{"code":"361","type":"RC"},{"code":"28430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":230,"gross_charge":240,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Oxygen, 1-12 Hours Charge","code_information":[{"code":"3950012","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3950012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":230,"gross_charge":240,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Silver Soaker Cath","code_information":[{"code":"4301163","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301163","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":230,"gross_charge":240,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Viscoelastic ( Sightpath )","code_information":[{"code":"4300917","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300917","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":230,"gross_charge":240,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Home Visit Level 3 Established99349","code_information":[{"code":"3332279","type":"CDM"},{"code":"522","type":"RC"},{"code":"99349","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":230,"gross_charge":240,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"99316 Nursing Facility (More Than 30 Min) Charge","code_information":[{"code":"3331354","type":"CDM"},{"code":"524","type":"RC"},{"code":"99316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":147,"maximum":230,"gross_charge":240,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":147}]}]},{"description":"Orthocord 2","code_information":[{"code":"4301153","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301153","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":145,"maximum":228,"gross_charge":237,"discounted_cash":213,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":228},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":145}]}]},{"description":"Spiriva Handihaler  (Tiotropium Bromide) 18mcg Inhalant [Gmh]","code_information":[{"code":"4503964","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597007575","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":145,"maximum":227,"gross_charge":236,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":146}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Alprostadil 0.5 Mg/ml Sol [Gmh]","code_information":[{"code":"4505096","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009316901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":145,"maximum":227,"gross_charge":236,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":227},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":146}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tc99m Oxidronate Per Vial (Hdp)","code_information":[{"code":"4067550","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":226,"gross_charge":235,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Pt Evaluation Moderate Complexity Units","code_information":[{"code":"4200147-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":144,"maximum":226,"gross_charge":235,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"New patient office or other outpatient visit, 60 min","code_information":[{"code":"3331710","type":"CDM"},{"code":"521","type":"RC"},{"code":"99205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":226,"gross_charge":235,"discounted_cash":212,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"99281 Fac Ed Level 1 -Room Charge","code_information":[{"code":"3601201","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":225,"gross_charge":234,"discounted_cash":211,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"3.5 Cortex Self-tap 24mm 204.824","code_information":[{"code":"4309846","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309846","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":225,"gross_charge":234,"discounted_cash":211,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Breast Lesion Wire 20g X 10.7","code_information":[{"code":"4301305","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301305","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":225,"gross_charge":234,"discounted_cash":211,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Granufoam Med Silver","code_information":[{"code":"4302061","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302061","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":144,"maximum":225,"gross_charge":234,"discounted_cash":211,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":144}]}]},{"description":"Compass For Lumbar Punct.","code_information":[{"code":"4301626","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301626","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":143,"maximum":224,"gross_charge":233,"discounted_cash":210,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":143}]}]},{"description":"Dantrolene 20 Mg Pow [Gmh]","code_information":[{"code":"4501076","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023012306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":143,"maximum":224,"gross_charge":233,"discounted_cash":210,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":224},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":144}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Therapeutic Phlebotomy 3","code_information":[{"code":"3800586","type":"CDM"},{"code":"309","type":"RC"},{"code":"99195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":141,"maximum":221,"gross_charge":230,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Patient Education, Nebulizer","code_information":[{"code":"3900050","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":141,"maximum":221,"gross_charge":230,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Barrel Bur 5.5 Mm (C)","code_information":[{"code":"4308929","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308929","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":141,"maximum":220,"gross_charge":229,"discounted_cash":206,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":141}]}]},{"description":"Pralidoxime 1. Gm Powder-inj [Gmh]","code_information":[{"code":"4502330","type":"CDM"},{"code":"250","type":"RC"},{"code":"60977014127","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":140,"maximum":219,"gross_charge":228,"discounted_cash":205,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":141}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Falope Rings","code_information":[{"code":"4303615","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303615","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":219,"gross_charge":228,"discounted_cash":205,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"Endoloop Pdsii","code_information":[{"code":"4303018","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":219,"gross_charge":228,"discounted_cash":205,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":219},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":140}]}]},{"description":"11102 Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion","code_information":[{"code":"3331339","type":"CDM"},{"code":"521","type":"RC"},{"code":"11102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139,"maximum":218,"gross_charge":227,"discounted_cash":204,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":139}]}]},{"description":"Tcc-ez Reg Cast","code_information":[{"code":"4300813","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300813","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":139,"maximum":217,"gross_charge":226,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":139}]}]},{"description":"Bladder Scan","code_information":[{"code":"3654500","type":"CDM"},{"code":"761","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":216,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Outpt Treatment Per Hr Charge","code_information":[{"code":"3105060","type":"CDM"},{"code":"761","type":"RC"},{"code":"CP3105060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":216,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ot Evaluation Moderate Complexity Units","code_information":[{"code":"4230065-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":138,"maximum":216,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Ot Evaluation High Complexity Units","code_information":[{"code":"4230064-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"97166","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":138,"maximum":216,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"27246 Cltx Greater Trochanter Femur W/o Man","code_information":[{"code":"3331923","type":"CDM"},{"code":"361","type":"RC"},{"code":"27246","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":216,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"99309 Subsequent Nursing Facility – High (25 Min) Wound Care Charge","code_information":[{"code":"3331863","type":"CDM"},{"code":"525","type":"RC"},{"code":"99309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138,"maximum":216,"gross_charge":225,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":138}]}]},{"description":"Insulin Glargine 100 Units/ml Subq 3 Ml Sol [Gmh]","code_information":[{"code":"4501378","type":"CDM"},{"code":"250","type":"RC"},{"code":"00088221905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":137,"maximum":215,"gross_charge":224,"discounted_cash":202,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":139}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Measles/mumps/rubella Virus Vaccinepow [Gmh]","code_information":[{"code":"3334217","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006468100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":137,"maximum":215,"gross_charge":224,"discounted_cash":202,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":139}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"5.5mm Tomcat Shaver","code_information":[{"code":"4303031","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":213,"gross_charge":222,"discounted_cash":200,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Abs Tip 0.9mm","code_information":[{"code":"4304029","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304029","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":213,"gross_charge":222,"discounted_cash":200,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Clip Fixing Device","code_information":[{"code":"4300293","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300293","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":213,"gross_charge":222,"discounted_cash":200,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Filiform Coude Tip 5fr","code_information":[{"code":"4306727","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306727","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":213,"gross_charge":222,"discounted_cash":200,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Filiform Straight Tip 5fr","code_information":[{"code":"4306729","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306729","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":213,"gross_charge":222,"discounted_cash":200,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Dicyclomine 10 Mg/ml Sol [Gmh]","code_information":[{"code":"4506094","type":"CDM"},{"code":"250","type":"RC"},{"code":"14789001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":136,"maximum":213,"gross_charge":222,"discounted_cash":200,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":138}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Crossflow Inflow Tubing ( C )","code_information":[{"code":"4300868","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300868","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":136,"maximum":212,"gross_charge":221,"discounted_cash":199,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":136}]}]},{"description":"Cardiac Rehab Phase Ii  Cp, Non-monitored","code_information":[{"code":"4000011","type":"CDM"},{"code":"943","type":"RC"},{"code":"93797","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":211,"gross_charge":220,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Urine Drug Screen 13","code_information":[{"code":"3800282","type":"CDM"},{"code":"301","type":"RC"},{"code":"80305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":211,"gross_charge":220,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Vitamin D Total","code_information":[{"code":"3806144","type":"CDM"},{"code":"301","type":"RC"},{"code":"82306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":211,"gross_charge":220,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"99309 Nh Visit  (Moderate Mdm)","code_information":[{"code":"3332273","type":"CDM"},{"code":"525","type":"RC"},{"code":"99309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":211,"gross_charge":220,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Benzocaine/butamben/tetracaine Top Aer [Gmh]","code_information":[{"code":"4500606","type":"CDM"},{"code":"250","type":"RC"},{"code":"10223020104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":135,"maximum":211,"gross_charge":220,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":136}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Endo Reloadable Clip App.","code_information":[{"code":"4300832","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300832","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":135,"maximum":211,"gross_charge":220,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":135}]}]},{"description":"Enoxaparin 100 Mg/ml 1 Ml Subq Sol [Gmh]","code_information":[{"code":"4503762","type":"CDM"},{"code":"250","type":"RC"},{"code":"00075062300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":134,"maximum":210,"gross_charge":219,"discounted_cash":197,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":136}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"28400 Cltx Calcaneal Fx W/o Man","code_information":[{"code":"3331932","type":"CDM"},{"code":"361","type":"RC"},{"code":"28400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134,"maximum":209,"gross_charge":218,"discounted_cash":196,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":134}]}]},{"description":"Leucovorin 350 Mg Pow [Gmh]","code_information":[{"code":"4504103","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021081630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":134,"maximum":209,"gross_charge":218,"discounted_cash":196,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":135}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Amoxicillin-clavulanate 250 Mg-62.5 Mg/5 Ml Oral Liq 75 Ml [Gmh]","code_information":[{"code":"4500299","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598020451","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":133,"maximum":208,"gross_charge":217,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":135}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Respiratory Syncytial Virus","code_information":[{"code":"3800507","type":"CDM"},{"code":"302","type":"RC"},{"code":"87420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":208,"gross_charge":217,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Q0084 Iv Chemo Per Visit Charge","code_information":[{"code":"3101125","type":"CDM"},{"code":"335","type":"RC"},{"code":"Q0084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":207,"gross_charge":216,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Blade Aggressive 5.0 Mm","code_information":[{"code":"4300218","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300218","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":207,"gross_charge":216,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Central Line Kit","code_information":[{"code":"4300458","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300458","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":207,"gross_charge":216,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Uv Cath Kit","code_information":[{"code":"4400187","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400187","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":207,"gross_charge":216,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"20526 Injection, Therapeutic (Eg. Local Anesthetic, Corticosteroid), Carpal Tunnel","code_information":[{"code":"3332475","type":"CDM"},{"code":"521","type":"RC"},{"code":"20526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133,"maximum":207,"gross_charge":216,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":133}]}]},{"description":"Blood test, comprehensive group of blood chemicals","code_information":[{"code":"3800920","type":"CDM"},{"code":"301","type":"RC"},{"code":"80053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":206,"gross_charge":215,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"97165 Telemedicine Ot Evaulationlow Complexity","code_information":[{"code":"4230066-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":132,"maximum":206,"gross_charge":215,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"97161 Telemedicine Pt Evaluation- Low Complexity","code_information":[{"code":"4200152-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":132,"maximum":206,"gross_charge":215,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Kam-vac Suction Tip","code_information":[{"code":"4301719","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301719","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":206,"gross_charge":215,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":132}]}]},{"description":"Grasping Tripod Forcep","code_information":[{"code":"4300235","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300235","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":131,"maximum":205,"gross_charge":214,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":131}]}]},{"description":"29240 Strapping Shoulder","code_information":[{"code":"3331965","type":"CDM"},{"code":"361","type":"RC"},{"code":"29240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":204,"gross_charge":212,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"King Airway 3 Yellow","code_information":[{"code":"3500399","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500399","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":204,"gross_charge":212,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Suction/irrigator Disposable (C)","code_information":[{"code":"4308910","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308910","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":204,"gross_charge":212,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Tx360 Syringe Kit","code_information":[{"code":"3500001","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":204,"gross_charge":212,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Bone Marrow Biopsy Tray","code_information":[{"code":"4300848","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300848","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":203,"gross_charge":211,"discounted_cash":190,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"4.0mm Tomcat (C)","code_information":[{"code":"4300052","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300052","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":203,"gross_charge":211,"discounted_cash":190,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":130}]}]},{"description":"Rotavirus (Rv1) (2 Dose) Vaccine Charge","code_information":[{"code":"1110136008","type":"CDM"},{"code":"636","type":"RC"},{"code":"90681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130,"maximum":203,"gross_charge":211,"discounted_cash":190,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":130}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Six Minute Walk Cp","code_information":[{"code":"4000085","type":"CDM"},{"code":"460","type":"RC"},{"code":"94618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"25560 Cltx Radial&ulnar Shaft Fractures W/o Man","code_information":[{"code":"3331916","type":"CDM"},{"code":"361","type":"RC"},{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":".Gtt 2hr Pp","code_information":[{"code":"3806119","type":"CDM"},{"code":"301","type":"RC"},{"code":"82951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":".Gtt-3 Hr","code_information":[{"code":"3800311","type":"CDM"},{"code":"301","type":"RC"},{"code":"82951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Creatine Kinase-mb","code_information":[{"code":"3800251","type":"CDM"},{"code":"301","type":"RC"},{"code":"82553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Vancomycin Trough","code_information":[{"code":"3806141","type":"CDM"},{"code":"301","type":"RC"},{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Urinary Catheter Insertion","code_information":[{"code":"3334201","type":"CDM"},{"code":"761","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 10mm 204.810","code_information":[{"code":"4309839","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309839","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 20mm 204.820","code_information":[{"code":"4309844","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309844","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 22mm 204.822","code_information":[{"code":"4309845","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309845","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 26mm 204.826","code_information":[{"code":"4309847","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309847","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 28mm 204.828","code_information":[{"code":"4309848","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309848","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 32mm 204.832","code_information":[{"code":"4309850","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309850","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 34mm 204.834","code_information":[{"code":"4309851","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309851","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 36mm 204.836","code_information":[{"code":"4309852","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309852","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 38mm 204.838","code_information":[{"code":"4309853","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309853","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"3.5 Cortex Self-tap 40mm 204.840","code_information":[{"code":"4309854","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309854","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Airvo Tube Kit (C)","code_information":[{"code":"4302534","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302534","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Barrel Bur 4.0mm","code_information":[{"code":"4308927","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308927","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Guide Wire","code_information":[{"code":"4308976","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308976","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Guidewire Angled","code_information":[{"code":"4309011","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Marigen Micro 38cm","code_information":[{"code":"4308112","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Mepilex 4x8 Ag","code_information":[{"code":"4300715","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300715","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Retrieval Pouch 3 X 6 (C)","code_information":[{"code":"4309058","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309058","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Test Stim Lead","code_information":[{"code":"4301929","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301929","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Trocar 12mm Dilating Tip","code_information":[{"code":"4301908","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301908","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"11107 Incisional Biopsy Of Skin (Eg, Wedge) (Including Simple Closure, When Performed); Each Separat","code_information":[{"code":"3331345","type":"CDM"},{"code":"521","type":"RC"},{"code":"11107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":129}]}]},{"description":"Hydrocortisone/neomycin/polymyxin B Otic Soln 1%-0.35%-10000 Units/ml Sol[gmh]","code_information":[{"code":"4503205","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":129,"maximum":202,"gross_charge":210,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":130}]}],"drug_information":{"unit":10000,"type":"UN"}},{"description":"Ot Evaluation Low Complexity Units","code_information":[{"code":"4230063-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":128,"maximum":201,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Phillips Follower 10fr","code_information":[{"code":"4306752","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306752","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":201,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Phillips Follower 12fr","code_information":[{"code":"4306753","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306753","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":201,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Phillips Follower 14fr","code_information":[{"code":"4306754","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306754","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":201,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Phillips Follwer 16fr","code_information":[{"code":"4306755","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306755","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":201,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Phillips Follower 18fr","code_information":[{"code":"4306756","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306756","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":201,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Phillips Follower 20fr","code_information":[{"code":"4306757","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306757","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":201,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Phillips Follower 22fr","code_information":[{"code":"4306758","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306758","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":201,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Meningococcal Conjugate Vaccine, Serogroups A, C, Y And W-135 (Tetravalent), For Im Use Poc","code_information":[{"code":"3332247","type":"CDM"},{"code":"636","type":"RC"},{"code":"90734","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":201,"gross_charge":209,"discounted_cash":188,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":201},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"57160 Fitting And Insertion Of Pessary Or Other Intravaginal Support Device","code_information":[{"code":"3334007","type":"CDM"},{"code":"57160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":128,"maximum":200,"gross_charge":208,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Us Nuchal Translucency Addl","code_information":[{"code":"3740079-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76814","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":128,"maximum":200,"gross_charge":208,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128}]}]},{"description":"Rifaximin 550 Mg Tab [Gmh]","code_information":[{"code":"4507131","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649030302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":128,"maximum":200,"gross_charge":208,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Sotradecol 1% (20mg/2ml) (Sodium Tetradecyl Sulfate) Inj. [Gmh]","code_information":[{"code":"4501139","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457016202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":128,"maximum":200,"gross_charge":208,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Thrombin Topical Recombinant 5000 Intl Uni Powder-recon","code_information":[{"code":"4506072","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338032201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":126,"maximum":198,"gross_charge":206,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":128}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Tc99m Albumin Aggr Up To 10mci (Maa)","code_information":[{"code":"4060013","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Tc99m Sulfur Colloid Per Vial","code_information":[{"code":"4060011","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Outpatient Hearing Screen Charge","code_information":[{"code":"3330010","type":"CDM"},{"code":"510","type":"RC"},{"code":"92551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Yesevaluation Charge","code_information":[{"code":"4230057-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"CP4230057GO","type":"LOCAL","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Pt Evaluation Low Complexity Units","code_information":[{"code":"4200146-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Yesevaluation Charge","code_information":[{"code":"4200141-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"CP4200141GP","type":"LOCAL","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Us Fetal Doppler Echo Comp","code_information":[{"code":"3740073-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76827","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Xr Tmj Open +Closed Lt","code_information":[{"code":"3700107-TC","type":"CDM"},{"code":"320","type":"RC"},{"code":"70328","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Agressive Shaver Tip 2.5mm","code_information":[{"code":"4303025","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303025","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Readywrap Calf Xl Tall","code_information":[{"code":"4302031","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Readywrap Calf Medium","code_information":[{"code":"4302037","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Readywrap Calf Large","code_information":[{"code":"4302042","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302042","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Readywrap Calf Large Black","code_information":[{"code":"4302054","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302054","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Resector Shaver Blade 5.5mm (C)","code_information":[{"code":"4303029","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303029","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"99304 Initial Nursing Facility – Low (25 Min) Wound Care Charge","code_information":[{"code":"3331858","type":"CDM"},{"code":"525","type":"RC"},{"code":"99304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":197,"gross_charge":205,"discounted_cash":185,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":197},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Nm Tc99m Medronate To 30 Mci","code_information":[{"code":"4060055","type":"CDM"},{"code":"255","type":"RC"},{"code":"A9503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":196,"gross_charge":204,"discounted_cash":184,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":125}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"94664 Rt Flutter Valve Initial Charge Cpt","code_information":[{"code":"3900087","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":196,"gross_charge":204,"discounted_cash":184,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"94664 Rt Flutter Valve Subsequent Charge","code_information":[{"code":"3900088","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":196,"gross_charge":204,"discounted_cash":184,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"King Airway Pedi 2.5","code_information":[{"code":"3500403","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500403","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":196,"gross_charge":204,"discounted_cash":184,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Hepatitis A Adult Vaccine 1440 Units/ml Preservative Free Sus [Gmh]","code_information":[{"code":"4506030","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082652","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":125,"maximum":196,"gross_charge":204,"discounted_cash":184,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":126}]}],"drug_information":{"unit":1440,"type":"UN"}},{"description":"Hewson Suture Passers (C)","code_information":[{"code":"4301236","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301236","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":195,"gross_charge":203,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Ob Pack","code_information":[{"code":"4301055","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301055","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":195,"gross_charge":203,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Spine Table  Pt Care Kit","code_information":[{"code":"4300202","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300202","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":195,"gross_charge":203,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Switch Blade Scissor","code_information":[{"code":"4301649","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301649","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":195,"gross_charge":203,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Ceftriaxone 2. Gm Powder-inj [Gmh]","code_information":[{"code":"4503956","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781320995","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":125,"maximum":195,"gross_charge":203,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":126}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Colorado Needle Tip","code_information":[{"code":"4300453","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300453","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":195,"gross_charge":203,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":125}]}]},{"description":"Lateral J Brace Lg R (C)","code_information":[{"code":"4309019","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":124,"maximum":194,"gross_charge":202,"discounted_cash":182,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"Subcuticular Skin Stapler","code_information":[{"code":"4301283","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301283","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":124,"maximum":194,"gross_charge":202,"discounted_cash":182,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"1.25mm Non Thd Guide Wire 900.721","code_information":[{"code":"4309957","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309957","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":124,"maximum":194,"gross_charge":202,"discounted_cash":182,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":124}]}]},{"description":"Custom Splint 4","code_information":[{"code":"4308890","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308890","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":193,"gross_charge":201,"discounted_cash":181,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Mepilex 8x20 (C)","code_information":[{"code":"4300847","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300847","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"96368ed Iv Infusion Concurrent Charge","code_information":[{"code":"4401127","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Bill S-2 Alcian Blue","code_information":[{"code":"3800033","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Bill Tissue Processing, Level Iii","code_information":[{"code":"3800803","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"D-dimer","code_information":[{"code":"3800269","type":"CDM"},{"code":"301","type":"RC"},{"code":"85379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"15276 Apply Skin Sub To Head, Genitalia, Hands, Feet; Ea. Addl 25 Sq Cm (< Or = 3 Units)","code_information":[{"code":"3331815","type":"CDM"},{"code":"510","type":"RC"},{"code":"15276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"29580 Unna Bootrt","code_information":[{"code":"3331801","type":"CDM"},{"code":"510","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"29580 Unna Bootlt","code_information":[{"code":"3331800","type":"CDM"},{"code":"510","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"29580 Unna Bootbilateral","code_information":[{"code":"3331802","type":"CDM"},{"code":"510","type":"RC"},{"code":"29580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"97597 Debridement, Open Wound, First 20 Sq Cm Or Less","code_information":[{"code":"3331774","type":"CDM"},{"code":"510","type":"RC"},{"code":"97597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Us Doppler Fetal Umbilical Art","code_information":[{"code":"3740075-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76820","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Us Fetal Doppler Echo Fol-up","code_information":[{"code":"3740074-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"76828","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"5.5mm Unhooded 6-flute Bur","code_information":[{"code":"4303026","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Hinged Knee Support Xxl","code_information":[{"code":"4308983","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308983","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Round Bur 5.0mm 12-flute","code_information":[{"code":"4309006","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Tracheostomy Tube #8","code_information":[{"code":"4301868","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301868","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Psychotherapy, 30 min","code_information":[{"code":"3331956","type":"CDM"},{"code":"900","type":"RC"},{"code":"90832","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"99304 Initial Nh (H&p Straightforward Or Low Mdm)","code_information":[{"code":"3331670","type":"CDM"},{"code":"525","type":"RC"},{"code":"99304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":123}]}]},{"description":"Albumin Human 25% Iv Sol 50 Ml [Gmh]","code_information":[{"code":"4503674","type":"CDM"},{"code":"250","type":"RC"},{"code":"68516521601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":123,"maximum":192,"gross_charge":200,"discounted_cash":180,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":124}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Etoposide 20 Mg/ml (500mg) Vial Sol [Gmh]","code_information":[{"code":"4507104","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323010425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":122,"maximum":191,"gross_charge":199,"discounted_cash":179,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":123}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tracheostomy Tube #6","code_information":[{"code":"4301867","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301867","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":191,"gross_charge":199,"discounted_cash":179,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Bionic Back Brace Xl","code_information":[{"code":"4302439","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302439","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":190,"gross_charge":198,"discounted_cash":178,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Lg Bionic Back Support","code_information":[{"code":"4302417","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302417","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":190,"gross_charge":198,"discounted_cash":178,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"29530 Strapping Knee","code_information":[{"code":"3331969","type":"CDM"},{"code":"361","type":"RC"},{"code":"29530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":190,"gross_charge":198,"discounted_cash":178,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Rtp Heated Tubing","code_information":[{"code":"4300869","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300869","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":190,"gross_charge":198,"discounted_cash":178,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":122}]}]},{"description":"Straight Micro-needle Electrode","code_information":[{"code":"4300369","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300369","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":121,"maximum":189,"gross_charge":197,"discounted_cash":177,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":121}]}]},{"description":"Arthroscopy Blade 5.5mm","code_information":[{"code":"4300221","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300221","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":188,"gross_charge":196,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Blade Saggittal 25mm ( C )","code_information":[{"code":"4301214","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301214","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":188,"gross_charge":196,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Morgan Lens (C)","code_information":[{"code":"4300997","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300997","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":188,"gross_charge":196,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Tx 60mm Reload","code_information":[{"code":"4301608","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301608","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":188,"gross_charge":196,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Tracheostomy Tube 3.0 Pef","code_information":[{"code":"4301864","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301864","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":187,"gross_charge":195,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Tracheostomy Tube 3.5 Pef","code_information":[{"code":"4301865","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301865","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":187,"gross_charge":195,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":120}]}]},{"description":"Blade Saggittal 13mm (C)","code_information":[{"code":"4301215","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301215","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":119,"maximum":186,"gross_charge":194,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":119}]}]},{"description":"Tranexamic Acid 100 Mg/ml Sol [Gmh]","code_information":[{"code":"4505031","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155052441","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":119,"maximum":186,"gross_charge":194,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":186},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":120}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Blade X-long Wide","code_information":[{"code":"4301221","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301221","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":185,"gross_charge":193,"discounted_cash":174,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":118}]}]},{"description":"Fluorescein 10% Iv Sol 5 Ml [Gmh]","code_information":[{"code":"4500066","type":"CDM"},{"code":"250","type":"RC"},{"code":"81298866003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":118,"maximum":185,"gross_charge":193,"discounted_cash":174,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":120}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Hip Pack ( C )","code_information":[{"code":"4308978","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308978","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":118,"maximum":184,"gross_charge":192,"discounted_cash":173,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":184},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":118}]}]},{"description":"Drill Bit 1.5mm W/ Stop","code_information":[{"code":"4300215","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300215","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":183,"gross_charge":191,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Drill Bit 2mm Short","code_information":[{"code":"4309097","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309097","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":183,"gross_charge":191,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Drill Wire Pass Short","code_information":[{"code":"4309063","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309063","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":183,"gross_charge":191,"discounted_cash":172,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Aerogen Solo Neb Replacement (C)","code_information":[{"code":"4302535","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302535","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":182,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"C7902 Each Additional 15 Min Remote Service Individual Psychotherapy","code_information":[{"code":"3331330","type":"CDM"},{"code":"914","type":"RC"},{"code":"C7902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":182,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Electrolytes 3","code_information":[{"code":"3800930","type":"CDM"},{"code":"301","type":"RC"},{"code":"80051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":182,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Blade Aggressive 3.5mm","code_information":[{"code":"4300194","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300194","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":182,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"99215 Level 5 Virtual Visit40 Min","code_information":[{"code":"3331705","type":"CDM"},{"code":"521","type":"RC"},{"code":"99215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":182,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Latanoprost Ophthalmic 0.005% Sol [Gmh]","code_information":[{"code":"4505032","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":117,"maximum":182,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":118}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Sumatriptan 6 Mg/0.5 Ml Sol [Gmh]","code_information":[{"code":"4501356","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150017301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":117,"maximum":182,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":118}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Paclitaxel 6 Mg/ml 16.7 Ml Sol [Gmh]","code_information":[{"code":"4504035","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703476681","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":117,"maximum":182,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":118}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Heated Rtp Insufflation Tubing ( C ) (Do Not Order)","code_information":[{"code":"4300867","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300867","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":117,"maximum":182,"gross_charge":190,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":117}]}]},{"description":"Fluorouracil 50 Mg/ml 100ml Sol [Gmh]","code_information":[{"code":"4506031","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729027638","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":116,"maximum":181,"gross_charge":189,"discounted_cash":170,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Irinotecan 20 Mg/ml 5ml Sol [Gmh]","code_information":[{"code":"4507017","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009752903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":116,"maximum":181,"gross_charge":189,"discounted_cash":170,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Cisplatin 1 Mg/ml Sol 100 Ml [Gmh]","code_information":[{"code":"4501118","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323010365","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":115,"maximum":180,"gross_charge":188,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":117}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"1000ml Canister","code_information":[{"code":"4300758","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300758","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":180,"gross_charge":188,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Blade Aggressive 4.0mm","code_information":[{"code":"4301917","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301917","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":180,"gross_charge":187,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Reaction Web Knee Brace M/l","code_information":[{"code":"4302407","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302407","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":180,"gross_charge":187,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Reaction Web Knee Brace Xl/xxl","code_information":[{"code":"4302408","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302408","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":115,"maximum":180,"gross_charge":187,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":115}]}]},{"description":"Leucovorin 200 Mg Pow [Gmh]","code_information":[{"code":"4507081","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457052920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":115,"maximum":180,"gross_charge":187,"discounted_cash":168,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":116}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"2.4mm Ang Slit Knife","code_information":[{"code":"4300431","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300431","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":179,"gross_charge":186,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Oscillating Saw Blade 90mm 13/21mm 1.27mm","code_information":[{"code":"4301228","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301228","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":179,"gross_charge":186,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Readywrap Toe Med Left","code_information":[{"code":"4302030","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302030","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":179,"gross_charge":186,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Readywrap Toe Med Right","code_information":[{"code":"4302034","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302034","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":179,"gross_charge":186,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Med Simplace Dressing","code_information":[{"code":"4302059","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302059","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":179,"gross_charge":186,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":179},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Bard Hernia Mesh 6 X 6","code_information":[{"code":"4300789","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300789","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":178,"gross_charge":185,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Co-oximetry 2","code_information":[{"code":"3800239","type":"CDM"},{"code":"301","type":"RC"},{"code":"82375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":178,"gross_charge":185,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Pt Aquatic Rehab Units","code_information":[{"code":"4200295-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":114,"maximum":178,"gross_charge":185,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Heated Circuit Bi-level/cpap","code_information":[{"code":"4302537","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302537","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":114,"maximum":178,"gross_charge":185,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":114}]}]},{"description":"Pedi Padz","code_information":[{"code":"4300564","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300564","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":177,"gross_charge":184,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Flumazenil 0.1 Mg/ml 10 Ml Iv Sol [Gmh]","code_information":[{"code":"4501121","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323042410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":177,"gross_charge":184,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":114}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Thora/paracen Kit ( C )","code_information":[{"code":"4303054","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303054","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":113,"maximum":177,"gross_charge":184,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":113}]}]},{"description":"Sugammadex 100 Mg/ml 2 Ml Inj Sol [Gmh]","code_information":[{"code":"4505050","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006542312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":112,"maximum":176,"gross_charge":183,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":113}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Blade Saggittal 18.0mm","code_information":[{"code":"4301219","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301219","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":176,"gross_charge":183,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Veralink Cassette","code_information":[{"code":"4300745","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300745","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":176,"gross_charge":183,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Circlamp 1.45cm Bell (C)","code_information":[{"code":"4300497","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300497","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":175,"gross_charge":182,"discounted_cash":164,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Prolonged Physician Service Without Direct Patient Contact First Hour99358 (Mgh)","code_information":[{"code":"3332424","type":"CDM"},{"code":"521","type":"RC"},{"code":"99358","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":175,"gross_charge":182,"discounted_cash":164,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":112}]}]},{"description":"Ref Antibody Id","code_information":[{"code":"3800090","type":"CDM"},{"code":"302","type":"RC"},{"code":"86870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"96372ed Subq/im Injection","code_information":[{"code":"3105065","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"99202 Office Visit New Pt- Sfw Mdm","code_information":[{"code":"3331202","type":"CDM"},{"code":"521","type":"RC"},{"code":"99202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Folate","code_information":[{"code":"3806139","type":"CDM"},{"code":"301","type":"RC"},{"code":"82746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Kidney function panel test","code_information":[{"code":"3800960","type":"CDM"},{"code":"301","type":"RC"},{"code":"80069","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Vitamin B12","code_information":[{"code":"3806138","type":"CDM"},{"code":"301","type":"RC"},{"code":"82607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"96523 Irrigation Implanted Vad Charge","code_information":[{"code":"3610527","type":"CDM"},{"code":"761","type":"RC"},{"code":"96523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Ot Iontophoresis Assistant Units","code_information":[{"code":"4230060-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97033","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"94200 Mvv Charge","code_information":[{"code":"3900107","type":"CDM"},{"code":"460","type":"RC"},{"code":"94200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Custom Splint 3","code_information":[{"code":"4308889","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308889","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Tru Pull Md R Brace (C)","code_information":[{"code":"4302452","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302452","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Mepilex 4x8","code_information":[{"code":"4300705","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300705","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":110,"maximum":173,"gross_charge":180,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":110}]}]},{"description":"Vinblastine 1mg/ml 10 Ml Vial [Gmh]","code_information":[{"code":"4506079","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":110,"maximum":172,"gross_charge":179,"discounted_cash":161,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":111}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"P9612 Cath Bldr For Urine Specimen","code_information":[{"code":"3331973","type":"CDM"},{"code":"361","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":171,"gross_charge":178,"discounted_cash":160,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Ultrasling, Xlarge","code_information":[{"code":"4302370","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302370","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":109,"maximum":170,"gross_charge":177,"discounted_cash":159,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":170},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":109}]}]},{"description":"Arthroscopy Tubing Set","code_information":[{"code":"4300198","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300198","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":169,"gross_charge":176,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Isovue-300 100 Ml Bottle [Gmh]","code_information":[{"code":"3761002","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270131535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":108,"maximum":169,"gross_charge":176,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":109}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Albuterol Inhaler 90 Mcg/inh [Gmh]","code_information":[{"code":"4506097","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310057922","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":108,"maximum":169,"gross_charge":176,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":109}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Stat Padz (C)","code_information":[{"code":"4300562","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300562","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":108,"maximum":169,"gross_charge":176,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":108}]}]},{"description":"Ffp Thawed Cp2d","code_information":[{"code":"3820300","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Bill Helicobacter, Spec Stain","code_information":[{"code":"3800834","type":"CDM"},{"code":"310","type":"RC"},{"code":"88312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Wound Vac Daily Charge","code_information":[{"code":"4302008","type":"CDM"},{"code":"279","type":"RC"},{"code":"CP4302008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Ot Reevaluation Units","code_information":[{"code":"4230062-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Pt Work Hardening Initial 2 Hours Rehab Units","code_information":[{"code":"4800149-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97545","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Pt Work Hardening-each Addl Hour Rehab Units","code_information":[{"code":"4200117-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97546","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Yes- Pt Work Hardening Chargework Hardening Charge","code_information":[{"code":"4800149","type":"CDM"},{"code":"424","type":"RC"},{"code":"97545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"15272 Apply Skin Sub To Trunk, Arms, Legs; Ea. Addl 25 Sq Cm (< Or = 3 Units)","code_information":[{"code":"3331814","type":"CDM"},{"code":"510","type":"RC"},{"code":"15272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Nm Macroaggregated Albumin","code_information":[{"code":"4066071","type":"CDM"},{"code":"255","type":"RC"},{"code":"A4641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Lap Cholang Catheter","code_information":[{"code":"4300966","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300966","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Monofocal Iols Staar ( Sightpath )","code_information":[{"code":"4300961","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300961","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Precise Core 14ga X 10cm","code_information":[{"code":"4300297","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300297","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Traxi Panniculus Retractor","code_information":[{"code":"4301900","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301900","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"I-prism Clips","code_information":[{"code":"4300364","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300364","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"New patient office or other outpatient visit, 45 min","code_information":[{"code":"3331709","type":"CDM"},{"code":"521","type":"RC"},{"code":"99204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Carboplatin 150 Mg Vial [Gmh]","code_information":[{"code":"4503010","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758004702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":109}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"The Breather","code_information":[{"code":"4302502","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302502","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":168,"gross_charge":175,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":168},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Hepatitis B Adult Vaccine 20 Mcg/ml Sus [Gmh]","code_information":[{"code":"4506014","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":167,"gross_charge":174,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":108}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ref Antigen Type","code_information":[{"code":"3800091","type":"CDM"},{"code":"302","type":"RC"},{"code":"86905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":167,"gross_charge":174,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Flex Cystoscope Needle","code_information":[{"code":"4301906","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301906","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":167,"gross_charge":174,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Optiflow Pedi Xl","code_information":[{"code":"4302530","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302530","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":107,"maximum":167,"gross_charge":174,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":107}]}]},{"description":"Aerogen Adult Nebulizer","code_information":[{"code":"4302528","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302528","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":166,"gross_charge":173,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"51702 Insertion Of Temporary Indwelling Bladder Catheter (Simple)","code_information":[{"code":"3331726","type":"CDM"},{"code":"521","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":166,"gross_charge":173,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Troponin Poc","code_information":[{"code":"3806136","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":165,"gross_charge":172,"discounted_cash":155,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Hemaclear Large Orange","code_information":[{"code":"4305064","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305064","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":165,"gross_charge":172,"discounted_cash":155,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Keratome Knife 2.8mm","code_information":[{"code":"4300315","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300315","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":165,"gross_charge":172,"discounted_cash":155,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Or Washer 13.0mm","code_information":[{"code":"4300048","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300048","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":165,"gross_charge":172,"discounted_cash":155,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Scd Stockings Knee High Xlg","code_information":[{"code":"4308880","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308880","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":165,"gross_charge":172,"discounted_cash":155,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":106}]}]},{"description":"Iron Sucrose 20 Mg/ml 5 Ml  Iv Sol [Gmh]","code_information":[{"code":"4503562","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":105,"maximum":164,"gross_charge":171,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":106}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Blade Micro Bent Coarse Offset 5.5 X 9 X 64","code_information":[{"code":"4309127","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309127","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":164,"gross_charge":171,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"17250 Chemical Cauterization Of Granulation Tissue","code_information":[{"code":"3332463","type":"CDM"},{"code":"521","type":"RC"},{"code":"17250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105,"maximum":164,"gross_charge":171,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":105}]}]},{"description":"Xenon 133 Per 10 Mcl","code_information":[{"code":"4060014","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":163,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Ammonia Level","code_information":[{"code":"3800050","type":"CDM"},{"code":"301","type":"RC"},{"code":"82140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":163,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Newborn Screening Pro","code_information":[{"code":"3800840","type":"CDM"},{"code":"309","type":"RC"},{"code":"83789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":163,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Pregnancy Test Serum","code_information":[{"code":"3800464","type":"CDM"},{"code":"302","type":"RC"},{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":163,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Hcg Quantitative","code_information":[{"code":"3800322","type":"CDM"},{"code":"301","type":"RC"},{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":163,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":104}]}]},{"description":"Oxaliplatin 5 Mg/ml 10 Ml Sol [Gmh]","code_information":[{"code":"4505042","type":"CDM"},{"code":"250","type":"RC"},{"code":"00955173110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":104,"maximum":163,"gross_charge":170,"discounted_cash":153,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":105}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bss+ ( Sightpath )","code_information":[{"code":"4300919","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300919","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":161,"gross_charge":168,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Endo Long Clip","code_information":[{"code":"4300833","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300833","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":161,"gross_charge":168,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Hemorrhoidal Band Ligator (C)","code_information":[{"code":"4308898","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308898","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":161,"gross_charge":168,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Mityone Pump W/mushroom Cup","code_information":[{"code":"4301081","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301081","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":160,"gross_charge":167,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Mityone Pump W/softbell Cup","code_information":[{"code":"4301089","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301089","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":160,"gross_charge":167,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"29130 Ed Application Finger Splint","code_information":[{"code":"3333078","type":"CDM"},{"code":"450","type":"RC"},{"code":"29130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":103,"maximum":160,"gross_charge":167,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":103}]}]},{"description":"Aprepitant 32 Mg/4.4 Ml Emu [Gmh]","code_information":[{"code":"4507195","type":"CDM"},{"code":"250","type":"RC"},{"code":"47426040110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":102,"maximum":159,"gross_charge":166,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":103}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"3m Vac Granufoam Dressing Kit, Large (C)","code_information":[{"code":"4302583","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302583","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":159,"gross_charge":166,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Alvarado Knee Holder Liner","code_information":[{"code":"4300659","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300659","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":159,"gross_charge":166,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Lopro Blade Size 1","code_information":[{"code":"3500306","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500306","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":159,"gross_charge":166,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"11105 Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/additional Lesi","code_information":[{"code":"3331342","type":"CDM"},{"code":"521","type":"RC"},{"code":"11105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":159,"gross_charge":166,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":102}]}]},{"description":"Arthroscopy Pack (C)","code_information":[{"code":"4301095","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301095","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":158,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Snap Dressing 15x15","code_information":[{"code":"4300839","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300839","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":158,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Liver function blood test","code_information":[{"code":"3800940","type":"CDM"},{"code":"301","type":"RC"},{"code":"80076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":158,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Basic metabolic panel","code_information":[{"code":"3806145","type":"CDM"},{"code":"300","type":"RC"},{"code":"80048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":158,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Basic metabolic panel","code_information":[{"code":"3805015","type":"CDM"},{"code":"301","type":"RC"},{"code":"80048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":158,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Amniotic Fluid Swab Poc","code_information":[{"code":"4300803","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300803","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":158,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Lopro Blade Size 2 (C)","code_information":[{"code":"3500307","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500307","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":158,"gross_charge":165,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 10mm 202.810","code_information":[{"code":"4309820","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309820","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 16mm 202.816","code_information":[{"code":"4309823","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309823","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 20mm 202.820","code_information":[{"code":"4309825","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309825","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 24mm 202.824","code_information":[{"code":"4309827","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309827","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 26mm 202.826","code_information":[{"code":"4309828","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309828","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 32mm 202.832","code_information":[{"code":"4309831","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309831","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 36mm 202.836","code_information":[{"code":"4309833","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309833","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 38mm 202.838","code_information":[{"code":"4309834","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309834","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 40mm 202.840","code_information":[{"code":"4309835","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309835","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 45mm 202.845","code_information":[{"code":"4309836","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309836","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"2.7 Cortex Self-tap 50mm 202.850","code_information":[{"code":"4309837","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309837","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Daptomycin 500 Mg Pow [Gmh]","code_information":[{"code":"4507078","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":102}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Anes- Epidural-spinal Tray","code_information":[{"code":"3500249","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500249","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":101,"maximum":157,"gross_charge":164,"discounted_cash":148,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":101}]}]},{"description":"Hand Orthosis Sm R","code_information":[{"code":"4302617","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302617","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":156,"gross_charge":163,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Biopsy Inst. Kit 20g X 16cm","code_information":[{"code":"4301301","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301301","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":156,"gross_charge":163,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Biopsy Inst. Kit 18g X 16cm","code_information":[{"code":"4301302","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301302","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":156,"gross_charge":163,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Biopsy Inst. Kit 18g X 20cm","code_information":[{"code":"4301303","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301303","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":100,"maximum":156,"gross_charge":163,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":100}]}]},{"description":"Bard Hernia Mesh 2 X 4","code_information":[{"code":"4300786","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300786","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":156,"gross_charge":162,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Urgok2 Lite 9-12","code_information":[{"code":"4301836","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301836","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":155,"gross_charge":161,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"29520  Strapping Hip","code_information":[{"code":"3331968","type":"CDM"},{"code":"361","type":"RC"},{"code":"29520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":155,"gross_charge":161,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Burr Round Cutting 4.8mm","code_information":[{"code":"4309048","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309048","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":99,"maximum":155,"gross_charge":161,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":99}]}]},{"description":"Moxifloxacin Ophthalmic 0.5% Sol","code_information":[{"code":"4507126","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078093926","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":99,"maximum":155,"gross_charge":161,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"99213 Office Visit Est Pt Low Mdm","code_information":[{"code":"3331270","type":"CDM"},{"code":"521","type":"RC"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Bill Tissue Processing, Level Ii","code_information":[{"code":"3800802","type":"CDM"},{"code":"310","type":"RC"},{"code":"88302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Coronavirus Sars Ag (Sofia)","code_information":[{"code":"3806118","type":"CDM"},{"code":"306","type":"RC"},{"code":"87635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Lactic Acid","code_information":[{"code":"3800406","type":"CDM"},{"code":"301","type":"RC"},{"code":"83605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Myoglobin Level","code_information":[{"code":"3805056","type":"CDM"},{"code":"301","type":"RC"},{"code":"83874","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Total prostate-specific antigen (PSA) test","code_information":[{"code":"3800476","type":"CDM"},{"code":"301","type":"RC"},{"code":"84153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Aerobika Oscillating System ( C )","code_information":[{"code":"4302519","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302519","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"99308 Subsequent Nursing Facility – Moderate (15 Min) Wound Care Charge","code_information":[{"code":"3331861","type":"CDM"},{"code":"525","type":"RC"},{"code":"99308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"20612 Aspiration And/or Injection Of Ganglion Cyst","code_information":[{"code":"3332474","type":"CDM"},{"code":"521","type":"RC"},{"code":"20612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Trypan Blue Ophthalmic 0.06% 0.5 Ml Sol [Gmh]","code_information":[{"code":"4503923","type":"CDM"},{"code":"250","type":"RC"},{"code":"68803061210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":99}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Nalbuphine 20 Mg/ml Sol [Gmh]","code_information":[{"code":"4506089","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409146701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":98,"maximum":154,"gross_charge":160,"discounted_cash":144,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":99}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"29540 Strapping Ankle/foot","code_information":[{"code":"3331970","type":"CDM"},{"code":"361","type":"RC"},{"code":"29540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":153,"gross_charge":159,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Digoxin Level","code_information":[{"code":"3800275","type":"CDM"},{"code":"300","type":"RC"},{"code":"80162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":153,"gross_charge":159,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"Adult Spacer","code_information":[{"code":"4302576","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302576","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":153,"gross_charge":159,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":98}]}]},{"description":"3.5 Cortex Self-tap 30mm 204.830","code_information":[{"code":"4309849","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309849","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":152,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"3.5 Cortex Self-tap 45mm 204.845","code_information":[{"code":"4309855","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309855","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":152,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"3.5 Cortex Self-tap 60mm 204.860","code_information":[{"code":"4309858","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309858","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":152,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Ankle Distractor Strap","code_information":[{"code":"4301138","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301138","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":152,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"99308 Nh Visit  (Low Mdm)","code_information":[{"code":"3331672","type":"CDM"},{"code":"525","type":"RC"},{"code":"99308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":152,"gross_charge":158,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":97}]}]},{"description":"Nalbuphine 10 Mg/ml Inj  10 Ml Sol [Gmh]","code_information":[{"code":"4501071","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069066110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":96,"maximum":151,"gross_charge":157,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":97}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"29260 Strapping Elbow/wrist","code_information":[{"code":"3331966","type":"CDM"},{"code":"361","type":"RC"},{"code":"29260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":151,"gross_charge":157,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Readywrap Knee Large","code_information":[{"code":"4302032","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302032","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":150,"gross_charge":156,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Readywrap Knee Medium","code_information":[{"code":"4302036","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":96,"maximum":150,"gross_charge":156,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":96}]}]},{"description":"Anti-coagulation Visit Charge","code_information":[{"code":"3331500","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":149,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Blood test, thyroid stimulating hormone (TSH)","code_information":[{"code":"3805069","type":"CDM"},{"code":"301","type":"RC"},{"code":"84443","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":149,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Pt Neuromuscular Reeducation Rehab Units","code_information":[{"code":"4200189-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":95,"maximum":149,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"20551 Injection, Tendon Origin/insertion","code_information":[{"code":"3332464","type":"CDM"},{"code":"521","type":"RC"},{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":149,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Hand Orthosis Med R","code_information":[{"code":"4302562","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302562","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":149,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Hand Orthosis Med L","code_information":[{"code":"4302618","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302618","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":149,"gross_charge":155,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Wound Cleanser 16oz","code_information":[{"code":"4301210","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301210","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":148,"gross_charge":154,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Endopath Probe Plus Ii Shaft (C)","code_information":[{"code":"4308993","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308993","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":148,"gross_charge":154,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Pathway Vaginal Emg/stimulation Sensor","code_information":[{"code":"4305062","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305062","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":148,"gross_charge":154,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Hyaluronidase 150 Units/ml Inj Sol [Gmh]","code_information":[{"code":"4501056","type":"CDM"},{"code":"250","type":"RC"},{"code":"18657011704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":95,"maximum":148,"gross_charge":154,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}],"drug_information":{"unit":150,"type":"UN"}},{"description":"Nasal Epistaxis Bil. 7.5","code_information":[{"code":"4300996","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300996","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":148,"gross_charge":154,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":148},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":95}]}]},{"description":"Cefdinir 125 Mg/5 Ml Pow [Gmh]","code_information":[{"code":"4507228","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877054798","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":94,"maximum":147,"gross_charge":153,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":95}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Mannitol 20% Sol [Gmh]","code_information":[{"code":"4506055","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338035703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":93,"maximum":146,"gross_charge":152,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":94}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Granufoam Medium Dressing","code_information":[{"code":"4300739","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300739","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":146,"gross_charge":152,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Suture Wire 19ga","code_information":[{"code":"4302162","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302162","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":146,"gross_charge":152,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Hand Orthosis Sm Left","code_information":[{"code":"4302616","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302616","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":146,"gross_charge":152,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Sleeve Kit 0.9mm","code_information":[{"code":"4304021","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":93,"maximum":145,"gross_charge":151,"discounted_cash":136,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":93}]}]},{"description":"Ambulatory Blood Pressure Monitor","code_information":[{"code":"4050050","type":"CDM"},{"code":"480","type":"RC"},{"code":"93784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Clinical Pharmacy Visit Charge","code_information":[{"code":"3331501","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Consult, Cardiologist","code_information":[{"code":"4000018","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Facility Level 3 Nurse Assist With Procedure Charge","code_information":[{"code":"3331506","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Facility Level 3 Wound Nurse Assists Wound Provider","code_information":[{"code":"3331509","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Lipase Level","code_information":[{"code":"3800395","type":"CDM"},{"code":"301","type":"RC"},{"code":"83690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Ct Cardiac Calcium Score","code_information":[{"code":"3760111-TC","type":"CDM"},{"code":"350","type":"RC"},{"code":"75571","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"20fr Coude W/5ml","code_information":[{"code":"4300416","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300416","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Blade Precision Thin, Offset 7.0 X 38 X 20.0","code_information":[{"code":"4309047","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309047","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Cook Cath 18fr 80cc","code_information":[{"code":"4302064","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302064","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Max-core Biopsy","code_information":[{"code":"4301003","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"S Curve Dilator 22fr (C)","code_information":[{"code":"4300217","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300217","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"S Curve Dilator 24fr (C)","code_information":[{"code":"4300269","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300269","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Ultrasling, Large ( C )","code_information":[{"code":"4302368","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302368","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Wrist Splint Whfo Lt Lg","code_information":[{"code":"4302514","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302514","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"99348 Home Or Residence Visit For The E/m Of Est Patient =/<30m","code_information":[{"code":"3332278","type":"CDM"},{"code":"522","type":"RC"},{"code":"99348","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Influenza A/b Poc Brady","code_information":[{"code":"112212005-QW","type":"CDM"},{"code":"306","type":"RC"},{"code":"87502","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Rsv Poc Brady Do Not Use","code_information":[{"code":"112212004-QW","type":"CDM"},{"code":"306","type":"RC"},{"code":"87807","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Insole Xl Left","code_information":[{"code":"4300850","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300850","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Surgifoam","code_information":[{"code":"4300108","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300108","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Ultrasling, Small ( C )","code_information":[{"code":"4302366","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302366","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Ultrasling, Medium ( C )","code_information":[{"code":"4302367","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302367","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":92,"maximum":144,"gross_charge":150,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":144},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":92}]}]},{"description":"Nasal Epistaxis 5.5","code_information":[{"code":"4301002","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":143,"gross_charge":149,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Cisplatin 1 Mg/ml Sol 50 Ml [Gmh]","code_information":[{"code":"4501078","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505627700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":91,"maximum":142,"gross_charge":148,"discounted_cash":133,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":92}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Mepilex 4x10 Post Op Ag (C)","code_information":[{"code":"4300849","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300849","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":91,"maximum":142,"gross_charge":148,"discounted_cash":133,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":91}]}]},{"description":"Scd Stockings Thigh High Lg","code_information":[{"code":"4308883","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308883","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":141,"gross_charge":147,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Knee Sleeve Md","code_information":[{"code":"4302440","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302440","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":141,"gross_charge":147,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Knee Sleeve Xl","code_information":[{"code":"4302441","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302441","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":141,"gross_charge":147,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Blood test, lipids","code_information":[{"code":"3800950","type":"CDM"},{"code":"301","type":"RC"},{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":140,"gross_charge":146,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Face Mask Bipap/cpap Lrg","code_information":[{"code":"4302541","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302541","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":140,"gross_charge":146,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Flyte Hood W/ Peel Away ( C )","code_information":[{"code":"4301106","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301106","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":140,"gross_charge":146,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":90}]}]},{"description":"Betamethasone Sodium Phosphate/ Betamethasone Acetate 6 Mg/ml (5 Ml Vial) [Gmh]","code_information":[{"code":"4500590","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517072001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":90,"maximum":140,"gross_charge":146,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":91}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Bill Sensitivity","code_information":[{"code":"3800541","type":"CDM"},{"code":"306","type":"RC"},{"code":"87186","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":139,"gross_charge":145,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Home Visit Level 2 New99342","code_information":[{"code":"3332013","type":"CDM"},{"code":"522","type":"RC"},{"code":"99342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":139,"gross_charge":145,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Verapamil 2.5 Mg/ml Sol [Gmh]","code_information":[{"code":"4506088","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069027105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":89,"maximum":139,"gross_charge":145,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Novii Patch (C)","code_information":[{"code":"4301127","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301127","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":89,"maximum":139,"gross_charge":145,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":89}]}]},{"description":"Suture Tape 1.3mm (C)","code_information":[{"code":"4302077","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302077","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":138,"gross_charge":144,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Continuous Passive Motion Cpm Daily Charge","code_information":[{"code":"4200114","type":"CDM"},{"code":"420","type":"RC"},{"code":"CP4200114","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":138,"gross_charge":144,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Rhophylac Injection 300 Mcg Charge","code_information":[{"code":"3334130","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":138,"gross_charge":144,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":88}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Hemaclear Medium Red","code_information":[{"code":"4305063","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305063","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":137,"gross_charge":143,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Spot Ex Endoscopic Marker ( C )","code_information":[{"code":"4300279","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300279","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":88,"maximum":137,"gross_charge":143,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":88}]}]},{"description":"Blood/fluid Warming Set  (C)","code_information":[{"code":"4301997","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301997","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":136,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Lateral J Patella  Sm L","code_information":[{"code":"4302438","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302438","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":136,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Lateral J Brace Xl L","code_information":[{"code":"4309014","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309014","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":136,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Lateral J Brace Lg Lft (C)","code_information":[{"code":"4309000","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":136,"gross_charge":142,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Chest Tube 12fr (C)","code_information":[{"code":"4300483","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300483","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":135,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Lopro Blade Size 3 (C)","code_information":[{"code":"3500308","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500308","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":135,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Lopro Blade Size 4 (C)","code_information":[{"code":"3500309","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500309","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":135,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Monodek Capio Suture ( C )","code_information":[{"code":"4301190","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301190","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":135,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Celox 3x5 Gauze","code_information":[{"code":"4300456","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300456","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":87,"maximum":135,"gross_charge":141,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":87}]}]},{"description":"Nitro-bid 2% / 30gm  Ointment    (Nitropaste, Nitroglycerin Oint.) [Gmh]","code_information":[{"code":"4501961","type":"CDM"},{"code":"250","type":"RC"},{"code":"00281032630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":134,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":87}]}],"drug_information":{"unit":30,"type":"GR"}},{"description":"Yesnon-selective Debridement Charge","code_information":[{"code":"4230129-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97602","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":86,"maximum":134,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Aquacel Ag 3 1/2 X 10","code_information":[{"code":"4300267","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300267","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":134,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Blade Long Medium","code_information":[{"code":"4300973","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300973","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":134,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Blade Thin Offset 9 X 38 X 25","code_information":[{"code":"4301227","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301227","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":134,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Nasal Epistaxis 4.5","code_information":[{"code":"4301015","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":134,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Daptomycin 350 Mg Pow [Gmh]","code_information":[{"code":"4507043","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594006601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":134,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":87}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Esomeprazole 40 Mg Pow [Gmh]","code_information":[{"code":"4506003","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436019082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":134,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":87}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Blade Micro 5.5 X 25 X 38 (C)","code_information":[{"code":"4309126","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309126","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":134,"gross_charge":140,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":86}]}]},{"description":"Enoxaparin 60 Mg/0.6 Ml Sc Sol [Gmh]","code_information":[{"code":"4504048","type":"CDM"},{"code":"250","type":"RC"},{"code":"00075062160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":85,"maximum":133,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":86}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Urgok2 Lite 7-9","code_information":[{"code":"4301835","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301835","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":133,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"4.0 Cancellous Full Thd 22mm 206.022","code_information":[{"code":"4309877","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309877","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":133,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"4.0 Cancellous Full Thd 60mm 206.060","code_information":[{"code":"4309887","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309887","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":133,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"4.0 Cancellous Part Thd 50mm 207.050","code_information":[{"code":"4309952","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309952","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":133,"gross_charge":139,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Thawed Plasma Cpd <24h","code_information":[{"code":"3806095","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":132,"gross_charge":138,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":85}]}]},{"description":"Phytonadione 10 Mg/ml Inj Sol 1 Ml [Gmh]","code_information":[{"code":"4503034","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409915801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":85,"maximum":132,"gross_charge":138,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":86}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Humi Uterine Manipulator","code_information":[{"code":"4303032","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303032","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":132,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Sport Ankle Splint Med","code_information":[{"code":"4301643","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301643","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":132,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Sport Ankle Splint X-lg ( C )","code_information":[{"code":"4301651","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301651","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":132,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Trocar Taut 5mm Long","code_information":[{"code":"4301937","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301937","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":132,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Wound Vac Canister","code_information":[{"code":"4302007","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":132,"gross_charge":137,"discounted_cash":123,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":84}]}]},{"description":"Irrisept Wound Lavage","code_information":[{"code":"4300550","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300550","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":131,"gross_charge":136,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Chest Tube Kit 20 Fr","code_information":[{"code":"4300507","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300507","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":131,"gross_charge":136,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Folate Level","code_information":[{"code":"3800298","type":"CDM"},{"code":"301","type":"RC"},{"code":"82746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Complete blood cell count (CBC), with differential white blood cells, automated","code_information":[{"code":"3800210","type":"CDM"},{"code":"305","type":"RC"},{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Free T4","code_information":[{"code":"3800582","type":"CDM"},{"code":"301","type":"RC"},{"code":"84439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Ot Self Care, Home Management Rehab Units","code_information":[{"code":"4230156-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97535","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Pt Self Care, Home Management Rehab Units","code_information":[{"code":"4230156-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97535","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"29530 Pt Strapping Knee Charge","code_information":[{"code":"4200183","type":"CDM"},{"code":"420","type":"RC"},{"code":"29530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"94760 Rt Pulse Oximetry Single Determination Charge","code_information":[{"code":"3900093","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Bacterial/viral Filter","code_information":[{"code":"4302536","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302536","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Atropine/hyoscyamine/pb/scopolamine 0.0194 Mg-0.1037 Mg-16.2 Mg-0.0065 Mg/5 Ml 120 Ml Eli [Gmh]","code_information":[{"code":"4502006","type":"CDM"},{"code":"250","type":"RC"},{"code":"59212042304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":84}]}],"drug_information":{"unit":194,"type":"ME"}},{"description":"Circlamp 1.1cm Bell (C)","code_information":[{"code":"4300499","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300499","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":83,"maximum":130,"gross_charge":135,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":83}]}]},{"description":"Amisulpride 5 Mg/2 Ml Sol [Gmh]","code_information":[{"code":"4507135","type":"CDM"},{"code":"250","type":"RC"},{"code":"71390012520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":82,"maximum":129,"gross_charge":134,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":83}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Acetaminophen 10 Mg/ml Sol 1000mg/100ml [Gmh]","code_information":[{"code":"4501266","type":"CDM"},{"code":"250","type":"RC"},{"code":"43825010201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":82,"maximum":129,"gross_charge":134,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":83}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hepatitis A Adult Vaccine Charge","code_information":[{"code":"1110136001","type":"CDM"},{"code":"636","type":"RC"},{"code":"90632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":129,"gross_charge":134,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":82}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ephedrine 50 Mg/ml Iv Only Sol [Gmh]","code_information":[{"code":"4506029","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478041510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":82,"maximum":129,"gross_charge":134,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":83}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"20552 Inj(s); Single Or Mult Trigger Point(s), One Or Two Muscle(s) Charge","code_information":[{"code":"3333072","type":"CDM"},{"code":"510","type":"RC"},{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82,"maximum":128,"gross_charge":133,"discounted_cash":120,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":82}]}]},{"description":"Iopromide 370 Mg/ml Sol Contrast [Gmh]","code_information":[{"code":"4507224","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419034610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":82,"maximum":128,"gross_charge":133,"discounted_cash":120,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}],"drug_information":{"unit":370,"type":"ME"}},{"description":"Ezdilate Inflation Device ( C )","code_information":[{"code":"4300259","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300259","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":127,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Iris Retractor","code_information":[{"code":"4300374","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300374","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":127,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Trocar Taut 12mm Long","code_information":[{"code":"4301938","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301938","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":127,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Custom Splint 2","code_information":[{"code":"4308888","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308888","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":127,"gross_charge":132,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":81}]}]},{"description":"Iprism Clip Sightpath","code_information":[{"code":"4300998","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300998","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":126,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Vitamin B12","code_information":[{"code":"3800660","type":"CDM"},{"code":"301","type":"RC"},{"code":"82607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":126,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Nm Mugatc99m","code_information":[{"code":"4068025","type":"CDM"},{"code":"636","type":"RC"},{"code":"A4641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":126,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Aquacel Ag 3 1/2 X 6","code_information":[{"code":"4300208","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300208","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":126,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Diphth/hepb/pertussis,acel/polio/tetanus Vaccine Poc","code_information":[{"code":"3331051","type":"CDM"},{"code":"636","type":"RC"},{"code":"90723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":126,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Q2038 Influenza High Dose 65+commercial","code_information":[{"code":"3335002","type":"CDM"},{"code":"636","type":"RC"},{"code":"90662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":126,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Amiodarone 360 Mg/200 Ml-d5% Sol [Gmh]","code_information":[{"code":"4507122","type":"CDM"},{"code":"250","type":"RC"},{"code":"43066036020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":126,"gross_charge":131,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":81}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Facility Level 2 Nurse Rooms Patient Charge","code_information":[{"code":"3331505","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Facility Level 2 Wound Provider","code_information":[{"code":"3331508","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"C-reactive Protein","code_information":[{"code":"3800265","type":"CDM"},{"code":"301","type":"RC"},{"code":"86140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Cbc With Manual Diff","code_information":[{"code":"3800211","type":"CDM"},{"code":"305","type":"RC"},{"code":"85007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"4230145-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97110","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Ot Therapeutic Activities Subsc Rehab Units","code_information":[{"code":"4230140-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97530","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Pt Iontophoresis Rehab Units","code_information":[{"code":"4200175-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Pt Re-evaluation Units","code_information":[{"code":"4200149-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97164","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"4200231-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Pt Therapeutic Activity Rehab Units","code_information":[{"code":"4230140-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Selective Debridement Addition Charge","code_information":[{"code":"4200129-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97598","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Circlamp 1.3cm Bell ( C )","code_information":[{"code":"4300495","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300495","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":80,"maximum":125,"gross_charge":130,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":80}]}]},{"description":"Eszopiclone 1 Mg Tab [Gmh]","code_information":[{"code":"4507184","type":"CDM"},{"code":"250","type":"RC"},{"code":"80725001030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":79,"maximum":124,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":80}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Abo/rh 8","code_information":[{"code":"3800005","type":"CDM"},{"code":"302","type":"RC"},{"code":"86900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":124,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Antibody Screen","code_information":[{"code":"3800095","type":"CDM"},{"code":"302","type":"RC"},{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":124,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Initial One-time Device Set-up","code_information":[{"code":"33370010","type":"CDM"},{"code":"761","type":"RC"},{"code":"99453","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":124,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Collection: Arterial Draw","code_information":[{"code":"3806092","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":124,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Collection: Port Draw","code_information":[{"code":"3806087","type":"CDM"},{"code":"761","type":"RC"},{"code":"36591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":124,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Collection: Picc","code_information":[{"code":"3806086","type":"CDM"},{"code":"761","type":"RC"},{"code":"36592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":124,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Chest Tube 28fr","code_information":[{"code":"4300487","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300487","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":79,"maximum":124,"gross_charge":129,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":79}]}]},{"description":"Doxorubicin Hcl 50mg/25ml (2mg/ml) (Adriamycin) [Gmh]","code_information":[{"code":"4502004","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069303220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":79,"maximum":123,"gross_charge":128,"discounted_cash":115,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Insulin Regular Human Recombinant 100 Units/ml 10ml  Sol [Gmh]","code_information":[{"code":"4507194","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002821501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":122,"gross_charge":127,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":79}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Hydralazine 20.  Soln [Gmh]","code_information":[{"code":"4501282","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478093401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":77,"maximum":121,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":78}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Pt Mechanical Traction Rehab Units","code_information":[{"code":"4200243-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":77,"maximum":121,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Professional Cgm Start Up / Training","code_information":[{"code":"33370004","type":"CDM"},{"code":"761","type":"RC"},{"code":"95250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":121,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Fat Emulsion, Intravenous 20% Emulsion [Gmh]","code_information":[{"code":"4500215","type":"CDM"},{"code":"250","type":"RC"},{"code":"65219053325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":77,"maximum":121,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":78}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Clonidine 100 Mcg/ml 10 Ml Sol [Gmh]","code_information":[{"code":"4502002","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457021810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":77,"maximum":121,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":78}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Methylprednisolone(solumedrol) 1000 Mg Inj [Gmh]","code_information":[{"code":"4502574","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009069802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":77,"maximum":121,"gross_charge":126,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":78}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Post Vasectomy","code_information":[{"code":"3800542","type":"CDM"},{"code":"307","type":"RC"},{"code":"89321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":120,"gross_charge":125,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Pt Manual Therapy Rehab Units","code_information":[{"code":"4200249-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":77,"maximum":120,"gross_charge":125,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"K Wire 1.6mm 292.71","code_information":[{"code":"4300011","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4300011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":120,"gross_charge":125,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"New patient office or other outpatient visit, 30 min","code_information":[{"code":"3331708","type":"CDM"},{"code":"521","type":"RC"},{"code":"99203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":120,"gross_charge":125,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Infant Transwarmer","code_information":[{"code":"4301951","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301951","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":77,"maximum":120,"gross_charge":125,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":77}]}]},{"description":"Pt Ultrasound Rehab Units","code_information":[{"code":"4200261-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":75,"maximum":118,"gross_charge":123,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"4.0 Cancellous Part Thd 26mm 207.026","code_information":[{"code":"4309896","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309896","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":118,"gross_charge":123,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Chest Tube 16fr (C)","code_information":[{"code":"4300498","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300498","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":118,"gross_charge":123,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Blade Medium Average 9 X 38 X 25","code_information":[{"code":"4309003","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":117,"gross_charge":122,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Fitting Diaphragm/cervical Cap Charge","code_information":[{"code":"CP17805909290682565","type":"CDM"},{"code":"CP17805909290682565","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":117,"gross_charge":122,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"11103 Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/additional Les","code_information":[{"code":"3331340","type":"CDM"},{"code":"521","type":"RC"},{"code":"11103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":117,"gross_charge":122,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Sodium Sulfacetamide Ophthalmic 10% Soln [Gmh]","code_information":[{"code":"4502621","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208067004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":75,"maximum":117,"gross_charge":122,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":76}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Clog Zapper System","code_information":[{"code":"4300120","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300120","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":117,"gross_charge":122,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":75}]}]},{"description":"Dexamethasone-tobramycin Ophthalmic 0.1%-0.3% Sus [Gmh[","code_information":[{"code":"4502805","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":116,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":75}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eye- Replacement Burr","code_information":[{"code":"4300644","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300644","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":116,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Filiform 2fr Spiral","code_information":[{"code":"4306749","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306749","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":116,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Filiform 3fr Coude","code_information":[{"code":"4306747","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306747","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":116,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Filiform 3fr Spiral","code_information":[{"code":"4306750","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306750","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":116,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Filiform 6fr Coude","code_information":[{"code":"4306748","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306748","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":116,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Filiform 6fr Spiral","code_information":[{"code":"4306751","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306751","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":116,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Filiform Straight Tip 2fr","code_information":[{"code":"4306745","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306745","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":116,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Filiform Straight Tip 6fr","code_information":[{"code":"4306746","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306746","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":116,"gross_charge":121,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Consult, Pulmonologist","code_information":[{"code":"4000025","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Chloride Level","code_information":[{"code":"3800227","type":"CDM"},{"code":"301","type":"RC"},{"code":"82435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Coagulation assessment blood test","code_information":[{"code":"3800425","type":"CDM"},{"code":"305","type":"RC"},{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Fetal Non-stress Test Office Charge","code_information":[{"code":"3331843","type":"CDM"},{"code":"510","type":"RC"},{"code":"59025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Occupational Health Physical Capacity Profile","code_information":[{"code":"4230007","type":"CDM"},{"code":"430","type":"RC"},{"code":"CP4230007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Transfer Charge","code_information":[{"code":"4200229-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Brace, Post-op Knee Med","code_information":[{"code":"4302425","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302425","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Insole Lg Left","code_information":[{"code":"4300846","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300846","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Insole Lg Right","code_information":[{"code":"4300844","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300844","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Insole Med Right","code_information":[{"code":"4300842","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300842","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"Insole Med Left","code_information":[{"code":"4300843","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300843","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":74,"maximum":115,"gross_charge":120,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":115},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":74}]}]},{"description":"10004 Fine Needle Aspiration Bx W/o Img Gdn Ea Addl.","code_information":[{"code":"3331881","type":"CDM"},{"code":"361","type":"RC"},{"code":"10004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":113,"gross_charge":118,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Blade Micro Flared Coarse","code_information":[{"code":"4301220","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301220","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":113,"gross_charge":118,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Blade X-long Wide Aggressive","code_information":[{"code":"4309060","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":113,"gross_charge":118,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Ot Manual Therapy Rehab Units","code_information":[{"code":"4230244-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97140","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":72,"maximum":112,"gross_charge":117,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Brace, Post-op Knee Univ ( C )","code_information":[{"code":"4302426","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302426","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":112,"gross_charge":117,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Surgicel 0.5  X 2 (C)","code_information":[{"code":"4302198","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302198","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":112,"gross_charge":117,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Surgicel 4 X 8 (C)","code_information":[{"code":"4301984","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301984","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":112,"gross_charge":117,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":72}]}]},{"description":"Fentanyl 50 Mcg/hr Transderm Er Film [Gmh]","code_information":[{"code":"4500986","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042647","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":112,"gross_charge":117,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":73}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mupirocin Top 2% Oint 22 Gm [Gmh]","code_information":[{"code":"4504076","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168035222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":71,"maximum":111,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":72}]}],"drug_information":{"unit":22,"type":"GR"}},{"description":"Readywrap Foot Large Right","code_information":[{"code":"4309069","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309069","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":111,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Readywrap Foot Right Small","code_information":[{"code":"4302038","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":111,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Readywrap Foot Left Small","code_information":[{"code":"4302039","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302039","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":111,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Readywrap Foot Medium Left","code_information":[{"code":"4302040","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":111,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Readywrap Foot Medium Right","code_information":[{"code":"4302041","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302041","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":111,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Readywrap Foot L Lg","code_information":[{"code":"4302043","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302043","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":111,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"65205 Remove Foreign Body From Eye","code_information":[{"code":"3332456","type":"CDM"},{"code":"521","type":"RC"},{"code":"65205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":111,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Moxifloxacin 1 Mg/ml Soln [Gmh]","code_information":[{"code":"4506005","type":"CDM"},{"code":"250","type":"RC"},{"code":"71449009642","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":71,"maximum":111,"gross_charge":116,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":72}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dexmedetomidine 100 Mcg/ml 2 Ml Vial Sol [Gmh]","code_information":[{"code":"4506047","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323042116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Mobile Cardiac Telemetry Event (Mct) Interp","code_information":[{"code":"4050026","type":"CDM"},{"code":"731","type":"RC"},{"code":"93228","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Facility Level 1 No Nurse Charge","code_information":[{"code":"3331504","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Facility Level 1 Wound Nurse","code_information":[{"code":"3331507","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Amylase Level","code_information":[{"code":"3800055","type":"CDM"},{"code":"301","type":"RC"},{"code":"82150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Bacterial Id Anaerobic Organism Atl","code_information":[{"code":"3800628","type":"CDM"},{"code":"306","type":"RC"},{"code":"87077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Creatine Kinase","code_information":[{"code":"3800240","type":"CDM"},{"code":"301","type":"RC"},{"code":"82550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Ot Neuromuscular Reeducation Rehab Units","code_information":[{"code":"4230090-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97112","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"4230067-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97110","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"97530 Telemedicine Ot Therapeutic Activities, One To One Each 15 Minutes","code_information":[{"code":"4230068-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97530","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Yesreevaluation Charge","code_information":[{"code":"4230058-GO","type":"CDM"},{"code":"434","type":"RC"},{"code":"CP4230058GO","type":"LOCAL","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Physical therapy, therapeutic exercise","code_information":[{"code":"4200153-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Gait Training Charges","code_information":[{"code":"4200151-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Yesreevaluation Charge","code_information":[{"code":"4200142-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"CP4200142GP","type":"LOCAL","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"94760 Noninvasive Pulse Ox Single Determination","code_information":[{"code":"3900112","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Aquacel Extra 6 X 6","code_information":[{"code":"4300753","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300753","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"King Airway Pedi 0","code_information":[{"code":"3500400","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500400","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"King Airway Pedi 1","code_information":[{"code":"3500401","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500401","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"King Airway Pedi 2","code_information":[{"code":"3500402","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500402","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Spatula Tip Disposable","code_information":[{"code":"4301624","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301624","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"99307 Subsequent Nursing Facility – Low (10 Min) Wound Care Charge","code_information":[{"code":"3331859","type":"CDM"},{"code":"525","type":"RC"},{"code":"99307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"99214 Level 4 Virtual Visit25 Min","code_information":[{"code":"3331704","type":"CDM"},{"code":"521","type":"RC"},{"code":"99214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"99307 Nh Visit (Straight Forward Mdm","code_information":[{"code":"3331675","type":"CDM"},{"code":"525","type":"RC"},{"code":"99307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71}]}]},{"description":"Influenza Virus Vaccine, Inactivated Preservative-free Trivalent Sus","code_information":[{"code":"4507150","type":"CDM"},{"code":"250","type":"RC"},{"code":"19515090452","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":71,"maximum":110,"gross_charge":115,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adult Lumbar","code_information":[{"code":"4301623","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301623","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":109,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Endoscopic Marker( Do Not Reorder)","code_information":[{"code":"4300298","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300298","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":109,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Ob Intra-uterine Cath","code_information":[{"code":"4301034","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301034","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":109,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Sodium Chloride 0.9% Iv Sol 250 Ml [Gmh]","code_information":[{"code":"4400252","type":"CDM"},{"code":"250","type":"RC"},{"code":"79672061330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":70,"maximum":109,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":71}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Angiocath 14ga X 3 1/2","code_information":[{"code":"4304100","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":109,"gross_charge":114,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":70}]}]},{"description":"Knee Brace Lg Economy","code_information":[{"code":"4302451","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302451","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":108,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Blade Reciprocating ( C )","code_information":[{"code":"4301222","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301222","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":108,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Interpulse Irrigation Set ( C )","code_information":[{"code":"4300088","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300088","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":108,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Kahook Blades Single Use Gonio Lens ( Sightpath )","code_information":[{"code":"4300948","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300948","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":108,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Smoke Evac Pencil ( Old One )","code_information":[{"code":"4301038","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":108,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Sutures 10-0 Nylon ( Sightpath )","code_information":[{"code":"4300944","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300944","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":108,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Acyclovir 50 Mg/ml 10 Ml Vial Sol [Gmh]","code_information":[{"code":"4506040","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032514","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":69,"maximum":108,"gross_charge":113,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":70}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nystatin Topical Powder 100,000units Per Gram (15gram Bottle) [Gmh]","code_information":[{"code":"4501019","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832046515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":69,"maximum":108,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}],"drug_information":{"unit":100000,"type":"UN"}},{"description":"Diltiazem 100 Mg/100ml Sol Premix [Gmh]","code_information":[{"code":"4507200","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567066210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":69,"maximum":108,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Anaform Comp Thigh Sleeve Blk Lg","code_information":[{"code":"4308959","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308959","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":108,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"20553 Anesth Single Or Multiple Trigger Point(s), 3 Or More Muscle(s)","code_information":[{"code":"3500553","type":"CDM"},{"code":"521","type":"RC"},{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":69,"maximum":108,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69}]}]},{"description":"Ceftriaxone 1 Gram [Gmh]","code_information":[{"code":"4503955","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505075204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":69,"maximum":108,"gross_charge":112,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"29260 Strapping Of Elbow Or Wrist","code_information":[{"code":"3331683","type":"CDM"},{"code":"521","type":"RC"},{"code":"29260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":107,"gross_charge":111,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Ot Aquatic Exercise Rehab Units","code_information":[{"code":"4230010-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97113","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Ot Attended E-stim Rehab Units","code_information":[{"code":"4230051-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97032","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Ot Orthotic Management, Train Rehab Units","code_information":[{"code":"4230105-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97760","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Ot Wheelchair Management Rehab Units","code_information":[{"code":"4230180-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97542","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Pt Attended E-stim Rehab Units","code_information":[{"code":"4200132-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Pt Unattended E-stim Rehab Units","code_information":[{"code":"4200131-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97014","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"97116 Telemedicine Gait Training","code_information":[{"code":"4200154-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Functional Training Charges","code_information":[{"code":"4200312-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Tens Setup Charge","code_information":[{"code":"4200330","type":"CDM"},{"code":"420","type":"RC"},{"code":"CP4200330","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Yes- Pt E-stim For Wound Other Chargee-stim For Wound Other Charge","code_information":[{"code":"4200277","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":68,"maximum":106,"gross_charge":110,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":68}]}]},{"description":"Injection Needle 23ga","code_information":[{"code":"4300294","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300294","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":105,"gross_charge":109,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Prolene 5-0 9702h","code_information":[{"code":"4302246","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302246","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":105,"gross_charge":109,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":67}]}]},{"description":"Lidocaine Top 4% Mucous Membrane Sol 4 Ml [Gmh]","code_information":[{"code":"4501643","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329630005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":67,"maximum":105,"gross_charge":109,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":68}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Finger Trap Md","code_information":[{"code":"4301240","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301240","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":103,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Finger Trap Lg","code_information":[{"code":"4301241","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301241","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":103,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Finger Trap X-lg","code_information":[{"code":"4301242","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301242","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":103,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Carbachol Ophth 0.01% Sol [Gmh]","code_information":[{"code":"4503745","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065002315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":103,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ephedrine 25 Mg/5 Ml-nacl 0.9% Preservative-free Sol [Gmh]","code_information":[{"code":"4507215","type":"CDM"},{"code":"250","type":"RC"},{"code":"71266902701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":103,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"29280 Strapping Hand/finger","code_information":[{"code":"3331967","type":"CDM"},{"code":"361","type":"RC"},{"code":"29280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":103,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"69209 Remvl Impacted Cerumen Irrigation/lvg Unilat","code_information":[{"code":"3331946","type":"CDM"},{"code":"361","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":103,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Dri-lok Cannula 8.0mm (C)","code_information":[{"code":"4308933","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308933","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":103,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Smoke Evac Pencil W/ Rs ( C )","code_information":[{"code":"4301067","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301067","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":66,"maximum":103,"gross_charge":107,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":66}]}]},{"description":"Adenosine 3 Mg/ Ml 2 Ml Soln [Gmh]","code_information":[{"code":"4503351","type":"CDM"},{"code":"250","type":"RC"},{"code":"00469823412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":65,"maximum":102,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":66}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Sodium Zirconium Cyclosilicate 10 G Pow [Gmh]","code_information":[{"code":"4507236","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310111030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":65,"maximum":102,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":66}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Cricothyrothomy Kit","code_information":[{"code":"4300503","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300503","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":102,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Ranger Tubing Set","code_information":[{"code":"4400173","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400173","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":102,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Tourn Cuff St 42 In","code_information":[{"code":"4305060","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":102,"gross_charge":106,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":65}]}]},{"description":"Bill Cytopath Concentration 88108","code_information":[{"code":"3800032","type":"CDM"},{"code":"310","type":"RC"},{"code":"88108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Magnesium Level","code_information":[{"code":"3800415","type":"CDM"},{"code":"301","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Pregnancy Test Urine","code_information":[{"code":"3805001","type":"CDM"},{"code":"302","type":"RC"},{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"S9443 Lactation Consult #1","code_information":[{"code":"3655015","type":"CDM"},{"code":"942","type":"RC"},{"code":"S9443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Ot Unattended E-stim Rehab Units","code_information":[{"code":"4230050-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97014","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Massage Charge Units","code_information":[{"code":"4230085-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97124","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Pt Massage Rehab Units","code_information":[{"code":"4200181-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97124","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Blade Saggittal Wide/thick ( C )","code_information":[{"code":"4301217","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301217","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Brace, Post-op Knee Sm","code_information":[{"code":"4302424","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302424","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Brace, Post-op Knee  Xlg","code_information":[{"code":"4302427","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302427","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Ear Spo2 Sensor (C)","code_information":[{"code":"4301229","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301229","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"I/a Tip ( Sightpath )","code_information":[{"code":"4300920","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300920","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Male External Cath Kit","code_information":[{"code":"4302005","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Patella Stabilizermedium","code_information":[{"code":"4308987","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308987","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Patella Stabilizer Large","code_information":[{"code":"4308988","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308988","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Patella Stabilizerxl","code_information":[{"code":"4308989","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308989","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"99423 21+ Min Virtual Visit","code_information":[{"code":"3331699","type":"CDM"},{"code":"521","type":"RC"},{"code":"99423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Azithromycin 200 Mg/5 Ml Oral Liq [Gmh]","code_information":[{"code":"4501069","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806014932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":64,"maximum":101,"gross_charge":105,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":65}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"4.0 Cancellous Part Thd 10mm 207.010","code_information":[{"code":"4309888","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309888","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 12mm 207.012","code_information":[{"code":"4309889","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309889","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 14mm 207.014","code_information":[{"code":"4309890","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309890","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 16mm 207.016","code_information":[{"code":"4309891","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309891","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 18mm 207.018","code_information":[{"code":"4309892","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309892","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 20mm 207.020","code_information":[{"code":"4309893","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309893","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 22mm 207.022","code_information":[{"code":"4309894","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309894","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 24mm 207.024","code_information":[{"code":"4309895","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309895","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 28mm 207.028","code_information":[{"code":"4309897","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309897","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 30mm 207.030","code_information":[{"code":"4309898","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309898","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 35mm 207.035","code_information":[{"code":"4309899","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309899","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 40mm 207.040","code_information":[{"code":"4309950","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309950","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"4.0 Cancellous Part Thd 45mm 207.045","code_information":[{"code":"4309951","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4309951","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Dry-doc Cannula 7mm X 8.5mm","code_information":[{"code":"4308999","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Liquiband Exceed","code_information":[{"code":"4301757","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301757","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Insulin Regular Human Recombinant 1 Unit/ml-nacl 0.9% Sol [Gmh]","code_information":[{"code":"4507090","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338012612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Edemawear Medium","code_information":[{"code":"4300579","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300579","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":100,"gross_charge":104,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":64}]}]},{"description":"Finger Trap Small","code_information":[{"code":"4301239","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301239","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":99,"gross_charge":103,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Jumpstart 4x4 Dressing (C)","code_information":[{"code":"4300551","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300551","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":99,"gross_charge":103,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Oxygen Limited Charge","code_information":[{"code":"3950025","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3950025","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":99,"gross_charge":103,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Olanzapine 10 Mg Pow [Gmh]","code_information":[{"code":"4507211","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781910572","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":99,"gross_charge":103,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":64}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Levetiracetam 100 Mg/ml 5 Ml Iv Sol [Gmh]","code_information":[{"code":"4500221","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756051344","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":98,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Brace- Atlas Minor Shoulder (C)","code_information":[{"code":"4301116","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301116","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":98,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Edemawear Small","code_information":[{"code":"4300576","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300576","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":98,"gross_charge":102,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":63}]}]},{"description":"Viscera Retainer (Fish)","code_information":[{"code":"4301946","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301946","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":97,"gross_charge":101,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Consult, Cardiac Defib","code_information":[{"code":"4000023","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Consult, Pacemaker","code_information":[{"code":"4000020","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"G0108 Diabetes Outpatient Self-management Training Services, Individual, Per 30 Minutes","code_information":[{"code":"4000036","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Inr Home Monitor Demonstration","code_information":[{"code":"3331499","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":".Gtt-4 Hr","code_information":[{"code":"3800309","type":"CDM"},{"code":"301","type":"RC"},{"code":"82952","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Hemoglobin A1c","code_information":[{"code":"3800315","type":"CDM"},{"code":"301","type":"RC"},{"code":"83036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Mononucleosis Screen","code_information":[{"code":"3800420","type":"CDM"},{"code":"302","type":"RC"},{"code":"86308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Protein Total","code_information":[{"code":"3805039","type":"CDM"},{"code":"301","type":"RC"},{"code":"84155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Strep A Screen","code_information":[{"code":"3800431","type":"CDM"},{"code":"306","type":"RC"},{"code":"87430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Medical Nutrition Education","code_information":[{"code":"3655000","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"59025 Nstfetal Non-stress Test Mfm","code_information":[{"code":"3740080-TC","type":"CDM"},{"code":"510","type":"RC"},{"code":"59025","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Ot Whirlpool, Fluidotherapy Rehab Units","code_information":[{"code":"4230185-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97022","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Yes- Ot Whirlpoolwhirlpool Extremity Charge","code_information":[{"code":"4230185","type":"CDM"},{"code":"431","type":"RC"},{"code":"97022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Yes- Therapeutic Procedures Group (2 Or More)group Therapy Charge","code_information":[{"code":"4230147-GO","type":"CDM"},{"code":"433","type":"RC"},{"code":"97150","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Tens Use Charge","code_information":[{"code":"4200227-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Yes- Pt Group Therapy Chargegroup Therapy Charge","code_information":[{"code":"4200224-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97150","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Aso Ankle Small","code_information":[{"code":"4303021","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Crescent Knife Blade","code_information":[{"code":"4300249","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300249","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Mask Ventilation Xlg","code_information":[{"code":"4302549","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302549","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"99417 Prolonged Service W Or W/o Direct Patient Contact On Date Of Office Or Other Outpatient","code_information":[{"code":"3331743","type":"CDM"},{"code":"521","type":"RC"},{"code":"99417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"96372  Therapeutic, Prophylactic, Or Diagnostic Injection, Subcutaneous Or Intramuscular; Clinic","code_information":[{"code":"3332257","type":"CDM"},{"code":"510","type":"RC"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Urine Pregnancy Test Poc Brady","code_information":[{"code":"112212008-QW","type":"CDM"},{"code":"307","type":"RC"},{"code":"81025","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":61,"maximum":96,"gross_charge":100,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Enoxaparin 40 Mg/0.4 Ml Sc Sol [Gmh]","code_information":[{"code":"4504047","type":"CDM"},{"code":"250","type":"RC"},{"code":"00075062040","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":95,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Needle Epidural 17ga X 5 (C)","code_information":[{"code":"4304186","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304186","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":95,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Tourn Cuff St 34 In ( C )","code_information":[{"code":"4305059","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305059","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":95,"gross_charge":99,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":61}]}]},{"description":"Mask Ventilation Lg (C)","code_information":[{"code":"4302548","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302548","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":94,"gross_charge":98,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Mask Ventilation Med","code_information":[{"code":"4302547","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302547","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":94,"gross_charge":98,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Mask Ventilation Sm","code_information":[{"code":"4302546","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302546","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":94,"gross_charge":98,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Hip Belt","code_information":[{"code":"4302344","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302344","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":93,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":60}]}]},{"description":"Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine And Poliovirus Vaccine, Inactivated (Dtap-i","code_information":[{"code":"3331068","type":"CDM"},{"code":"636","type":"RC"},{"code":"90696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":93,"gross_charge":97,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Sodium Ferric Gluconate Complex 12.5 Mg/ml Sol  [Gmh]","code_information":[{"code":"4506074","type":"CDM"},{"code":"250","type":"RC"},{"code":"00024279210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":59,"maximum":92,"gross_charge":96,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":60}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"69210 Remvl Impacted Cerumen Instrumentation","code_information":[{"code":"3331947","type":"CDM"},{"code":"361","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":92,"gross_charge":96,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":59}]}]},{"description":"Injector Force Needle 25ga","code_information":[{"code":"4300300","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300300","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":59,"maximum":92,"gross_charge":96,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":59}]}]},{"description":"Gtt Add On","code_information":[{"code":"3800351","type":"CDM"},{"code":"301","type":"RC"},{"code":"82952","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Dat 6","code_information":[{"code":"3800242","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"G0463 Hospital Outpatient Clinic Visit","code_information":[{"code":"3331329","type":"CDM"},{"code":"914","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Anklizer Low Pro.med ( C )","code_information":[{"code":"4308941","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308941","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Irrig Sol Glycine 3000","code_information":[{"code":"4300810","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300810","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"T-tube Adult","code_information":[{"code":"4307001","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4307001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Trocar 11mm Blunt","code_information":[{"code":"4301907","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301907","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Trocar 12mm Blunt","code_information":[{"code":"4301909","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301909","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Trocar 5mm Blunt ( C )","code_information":[{"code":"4301903","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301903","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"99202 Level 2 New Pt Virtual Visit20 Min","code_information":[{"code":"3331707","type":"CDM"},{"code":"521","type":"RC"},{"code":"99202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Home Visit Level 1 New99341","code_information":[{"code":"3332012","type":"CDM"},{"code":"522","type":"RC"},{"code":"99341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Strep Poc Brady","code_information":[{"code":"112212007-QW","type":"CDM"},{"code":"306","type":"RC"},{"code":"87880","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Anklizer Low Pro.sm ( C )","code_information":[{"code":"4308940","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308940","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":91,"gross_charge":95,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Anklizer Low Pro. Lrg","code_information":[{"code":"4308955","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308955","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Brace, Ankle, Swedo Med","code_information":[{"code":"4302433","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302433","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Brace, Ankle, Swedo Lg","code_information":[{"code":"4302434","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302434","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Brace, Ankle, Swedo Sm","code_information":[{"code":"4302432","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302432","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Brace, Ankle, Swedo Xlg","code_information":[{"code":"4302435","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302435","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Cold Snare 9mm","code_information":[{"code":"4300886","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300886","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Twist-in Cannula 8.25mm","code_information":[{"code":"4301099","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301099","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Twist-in Cannula 6mm","code_information":[{"code":"4301123","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301123","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Video Laryngoscope Blade","code_information":[{"code":"4301256","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301256","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58}]}]},{"description":"Vancomycin 125 Mg Cap Ud [Gmh]","code_information":[{"code":"4507125","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494045020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Acetylcysteine 20% Inh Sol 30 Ml [Gmh]","code_information":[{"code":"4500015","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":90,"gross_charge":94,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Chronic Care  20 Min Monthly Charge","code_information":[{"code":"33370001","type":"CDM"},{"code":"761","type":"RC"},{"code":"99490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":89,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Chest Tube 10fr","code_information":[{"code":"4300481","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300481","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":89,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Soft Tissue Biopsy Tray","code_information":[{"code":"4301300","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301300","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":57,"maximum":89,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":57}]}]},{"description":"Sodium Polystyrene Sulfonate 15 G/60 Ml Sus Ud [Gmh]","code_information":[{"code":"4503810","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":57,"maximum":89,"gross_charge":93,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":58}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Dri-lok Cannula 5.0mm","code_information":[{"code":"4308931","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308931","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":88,"gross_charge":92,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Pulmonary Biopsy Forcep","code_information":[{"code":"4300291","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300291","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":88,"gross_charge":92,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Imipenem-cilastatin 500 Mg-500 Mg Powder-inj [Gmh]","code_information":[{"code":"4502270","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":88,"gross_charge":92,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":57}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem/ Sodium Chloride Premix 1000 Mg [Gmh]","code_information":[{"code":"4507220","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264318511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":88,"gross_charge":92,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":57}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Tamponade","code_information":[{"code":"4300978","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300978","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":88,"gross_charge":92,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Cefepime 2 G/ 50 Ml [Gmh]","code_information":[{"code":"4507124","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264319511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":88,"gross_charge":92,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":57}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"V-lock 30cm","code_information":[{"code":"4301764","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301764","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":88,"gross_charge":92,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Tourn Cuff St 30in ( C )","code_information":[{"code":"4305058","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305058","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":87,"gross_charge":91,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Trocar 11mm Dilating Tip","code_information":[{"code":"4300954","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300954","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":87,"gross_charge":91,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":56}]}]},{"description":"Biatain Sacral 9x9 (C)","code_information":[{"code":"4301839","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Hepatitis B Pediatric Vaccine 10 Mcg/0.5 Ml Sus Acute [Gmh]","code_information":[{"code":"4506001","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":56}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Consult, Cardiologist","code_information":[{"code":"4000015","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Alt","code_information":[{"code":"3800045","type":"CDM"},{"code":"301","type":"RC"},{"code":"84460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Bill Tissue Processing, Level 1 (Gross Exam Only)","code_information":[{"code":"3800801","type":"CDM"},{"code":"314","type":"RC"},{"code":"88300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Sodium Level","code_information":[{"code":"3800545","type":"CDM"},{"code":"301","type":"RC"},{"code":"84295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Ot Sensory Integrative Techniques Rehab Units","code_information":[{"code":"4230042-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97533","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Ot Vasopneumatic Devices Rehab Units","code_information":[{"code":"4230047-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97016","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Yes- Pt Whirlpool Full Body Chargewhirlpool Full Body Charge","code_information":[{"code":"4200276-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97022","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Forehead Spo2 Sensor (C)","code_information":[{"code":"4301185","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301185","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Scd Stockings Knee High Lg ( C )","code_information":[{"code":"4308879","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308879","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"H1102-general Education And Health Promotion (Ppp Service)","code_information":[{"code":"33370006","type":"CDM"},{"code":"761","type":"RC"},{"code":"H1102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Surg Morphine 10 Mg/10 Ml (Duramorph) Preservative-free Inj Sol 10 Ml [Gmh]","code_information":[{"code":"4502018","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641601910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":86,"gross_charge":90,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":56}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nafcillin 2 G Pow [Gmh]","code_information":[{"code":"4505048","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032822","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":85,"gross_charge":89,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Charcoal-sorbitol 25 G Susp [Gmh]","code_information":[{"code":"4500045","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689020304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":85,"gross_charge":89,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Hepatitis B Vaccine Recombivax, Adult","code_information":[{"code":"3331054","type":"CDM"},{"code":"636","type":"RC"},{"code":"90746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":85,"gross_charge":89,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Suction Ring W/ Tubing (C)","code_information":[{"code":"4301740","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301740","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":85,"gross_charge":89,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Paclitaxel 6 Mg/ml 5 Ml Sol [Gmh]","code_information":[{"code":"4506099","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860020005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":85,"gross_charge":89,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Hybrid Tubing ( Olympus ) ( C )","code_information":[{"code":"4301193","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301193","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":85,"gross_charge":89,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":55}]}]},{"description":"Bill Uds","code_information":[{"code":"3809100","type":"CDM"},{"code":"309","type":"RC"},{"code":"CP3809100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":84,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Cath 24fr 3-way W/30ml","code_information":[{"code":"4300441","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300441","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":84,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Plain 3-0 Cp53g","code_information":[{"code":"4302333","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302333","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":84,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":54}]}]},{"description":"Proparacaine 0.5% Ophthalmic Solution 15ml (Refrigerator) [Gmh]","code_information":[{"code":"4504505","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":84,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":55}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Ropivacaine 0.5% (5mg/ml) 30ml [Gmh]","code_information":[{"code":"4503277","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323028638","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":84,"gross_charge":88,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":55}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Neostigmine 1 Mg/ml Sol 10 Ml [Gmh]","code_information":[{"code":"4504053","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323041510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":53,"maximum":84,"gross_charge":87,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":54}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nasal Spo2 Sensor","code_information":[{"code":"3500236","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500236","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":84,"gross_charge":87,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Optiflow Adult Small","code_information":[{"code":"4302533","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302533","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":84,"gross_charge":87,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Optiflow Adult Medium","code_information":[{"code":"4302532","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302532","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":84,"gross_charge":87,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Optiflow Adult Large","code_information":[{"code":"4302531","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302531","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":84,"gross_charge":87,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Trocar 5mm Dilating Tip","code_information":[{"code":"4300953","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300953","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":84,"gross_charge":87,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Hepatitis B Pediatric Vaccine Susp [Gmh]","code_information":[{"code":"4501253","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006498100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":53,"maximum":84,"gross_charge":87,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":54}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levofloxacin 500 Mg/100 Ml Sol [Gmh]","code_information":[{"code":"4504105","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143972101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":53,"maximum":83,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Flurbipro O/s 0.03%  Drp  2.5ml (Ocufen Opht. Solution) [Gmh]","code_information":[{"code":"4502030","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292072225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":53,"maximum":83,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"16fr Surestep Cath Tray ( C )","code_information":[{"code":"4300425","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300425","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":83,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Trocar 8mm Bladeless","code_information":[{"code":"4301911","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301911","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":83,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Ethibond 2 Mx69g","code_information":[{"code":"4302303","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302303","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":83,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Leep Ball Electrode","code_information":[{"code":"4303069","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303069","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":83,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Leep Radius Electrode 2cm X .8cm","code_information":[{"code":"4303073","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303073","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":83,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Chromic 6-0 790g","code_information":[{"code":"4302195","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302195","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":53,"maximum":83,"gross_charge":86,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":53}]}]},{"description":"Cooper Smoke Evacuator Tubing","code_information":[{"code":"4303070","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303070","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Ast","code_information":[{"code":"3800135","type":"CDM"},{"code":"301","type":"RC"},{"code":"84450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Bill Decalcification Procedure","code_information":[{"code":"3800512","type":"CDM"},{"code":"310","type":"RC"},{"code":"88311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Bleeding Time","code_information":[{"code":"3800151","type":"CDM"},{"code":"300","type":"RC"},{"code":"85002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Immunization Administration 1st Vaccine","code_information":[{"code":"3105063","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Ot Mechanical Traction Rehab Units","code_information":[{"code":"4230151-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97012","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Ot Paraffin Bath Rehab Units","code_information":[{"code":"4230115-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97018","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Ot Prosthetic Management, Train Rehab Units","code_information":[{"code":"4230125-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97761","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Pt Paraffin Rehab Units","code_information":[{"code":"4200191-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97018","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Pt Prosthetic Management, Train Rehab Units","code_information":[{"code":"4200206-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97761","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Pt Cognitive Skills Charge","code_information":[{"code":"4200041-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97532","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Brace, Post-op Knee Xxwide","code_information":[{"code":"4302558","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302558","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Ethiibond 5 Mb47g","code_information":[{"code":"4302307","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302307","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"High Flow Cannula Small","code_information":[{"code":"4302540","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302540","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"High Flow Cannula Medium","code_information":[{"code":"4302539","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302539","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"High Flow Cannula Large","code_information":[{"code":"4302538","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302538","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Tourn Cuff St 24 In","code_information":[{"code":"4305055","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305055","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Home Visit Level 1 Established99347","code_information":[{"code":"3332277","type":"CDM"},{"code":"522","type":"RC"},{"code":"99347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Dexmedetomidine 4 Mcg/ml-nacl 0.9% Sol [Gmh]","code_information":[{"code":"4507154","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781349395","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":53}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Pamidronate 3 Mg/ml Iv Sol 10 Ml [Gmh]","code_information":[{"code":"4503739","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457043010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":53}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Calcium Gluconate 100 Mg/ml 50 Ml Sol [Gmh]","code_information":[{"code":"4506025","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323036059","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":52,"maximum":82,"gross_charge":85,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":53}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Angiocath 12ga X 3","code_information":[{"code":"4304101","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304101","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":81,"gross_charge":84,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Chemo Spill Kit","code_information":[{"code":"4300476","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300476","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":81,"gross_charge":84,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Ethibond 5 Mb46g ( C )","code_information":[{"code":"4302057","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302057","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":81,"gross_charge":84,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Cast- Stockinette 3 Cotton","code_information":[{"code":"4301697","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301697","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":52,"maximum":81,"gross_charge":84,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":52}]}]},{"description":"Angiocath 14ga X 5 1/4 In","code_information":[{"code":"4304105","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304105","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Back Support Workforce","code_information":[{"code":"4308885","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308885","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Cath 22fr 3-way W/30ml","code_information":[{"code":"4300440","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300440","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Dermabond Pen (C)","code_information":[{"code":"4301753","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301753","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Fiberwire 2-0","code_information":[{"code":"4302066","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302066","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Fiberwire Size 2","code_information":[{"code":"4302065","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302065","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Kids Spacer","code_information":[{"code":"4302575","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302575","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Leep Square Condyloma Electrode","code_information":[{"code":"4303068","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303068","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Letz Electrode 9mm","code_information":[{"code":"4301101","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301101","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Letz Electrode 12mm","code_information":[{"code":"4301102","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301102","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Letz Electrode 11mm","code_information":[{"code":"4301108","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301108","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Letz Electrode 15mm","code_information":[{"code":"4301109","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301109","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Ceftriaxone 2 G/50 Ml-iso-osmotic Dextrose Sol Ud [Gmh]","code_information":[{"code":"4507112","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264315511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Belladonna-opium 16.2 Mg-30 Mg Supp [Gmh]","code_information":[{"code":"4500316","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574704512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":162,"type":"ME"}},{"description":"Yueh Ndl 5fr 10cm","code_information":[{"code":"4303078","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303078","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Yueh Ndl 5fr 15cm","code_information":[{"code":"4303079","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303079","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":80,"gross_charge":83,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":51}]}]},{"description":"Meropenem 1000 Mg Pow [Gmh]","code_information":[{"code":"4505044","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409139122","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":79,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":51}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ultrasound Charges","code_information":[{"code":"4230160-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97035","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":50,"maximum":79,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Ethilon 10-0 7757g","code_information":[{"code":"4300367","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300367","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":79,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Xylocaine Mpf 2% / Epinephrine 1:200,000 (Lidocaine/epi) 20ml [Gmh]","code_information":[{"code":"4503112","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":79,"gross_charge":82,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":51}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Tranexamic Acid 10 Mg/ml-nacl 0.7% Sol Premix [Gmh]","code_information":[{"code":"4507146","type":"CDM"},{"code":"250","type":"RC"},{"code":"80830232903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":78,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Alkaline Phosphatase","code_information":[{"code":"3800035","type":"CDM"},{"code":"301","type":"RC"},{"code":"84075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":78,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Plume-away","code_information":[{"code":"4301207","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301207","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":78,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Polysorb 2-0 Cl63","code_information":[{"code":"4301700","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301700","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":78,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Radial Artery Cath Kit","code_information":[{"code":"3500100","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":78,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Room/bed: Observation","code_information":[{"code":"3100100","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":78,"gross_charge":81,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":50}]}]},{"description":"Ketamine 10 Mg/ml 20 Ml  Inj Sol [Gmh]","code_information":[{"code":"4501291","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150043810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":50}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Anti-coagulation Recheck Visit Charge","code_information":[{"code":"3331502","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Clinical Pharmacy Recheck Visit Charge","code_information":[{"code":"3331503","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":".Glucose Fasting","code_information":[{"code":"3801075","type":"CDM"},{"code":"301","type":"RC"},{"code":"82951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Bill Afb Stain","code_information":[{"code":"3800031","type":"CDM"},{"code":"310","type":"RC"},{"code":"87206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Creatinine Level","code_information":[{"code":"3800260","type":"CDM"},{"code":"301","type":"RC"},{"code":"82565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Glucose Level","code_information":[{"code":"3800310","type":"CDM"},{"code":"301","type":"RC"},{"code":"82947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Koh Prep 2","code_information":[{"code":"3800661","type":"CDM"},{"code":"309","type":"RC"},{"code":"87210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Phosphorus Level","code_information":[{"code":"3800450","type":"CDM"},{"code":"301","type":"RC"},{"code":"84100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Platelet Count","code_information":[{"code":"3800455","type":"CDM"},{"code":"305","type":"RC"},{"code":"85049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Wet Prep/mount","code_information":[{"code":"3335016","type":"CDM"},{"code":"309","type":"RC"},{"code":"87210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"S9443 Lactation Consult Follow Up","code_information":[{"code":"3655016","type":"CDM"},{"code":"942","type":"RC"},{"code":"S9443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Ot Community, Work Reintegration Rehab Units","code_information":[{"code":"4230155-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97537","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Contrast Bathsmodalities Provided","code_information":[{"code":"4230030-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97034","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Pt Contrast Bath Rehab Units","code_information":[{"code":"4200108-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97034","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Pt Selective Debrid W/o Anes Units","code_information":[{"code":"4200128-GP","type":"CDM"},{"code":"420","type":"RC"},{"code":"97597","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Standardized Cognitive Eval Charge","code_information":[{"code":"4250125-GN","type":"CDM"},{"code":"440","type":"RC"},{"code":"97532","type":"CPT","modifier":"GN"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GN"],"minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"18fr 3-way W/5ml","code_information":[{"code":"4300446","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300446","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Aso Ankle 2xl","code_information":[{"code":"4303027","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Aso Ankle Brace Xsm","code_information":[{"code":"4304038","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304038","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Aso Ankle Large","code_information":[{"code":"4303024","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Aso Ankle Medium","code_information":[{"code":"4303023","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Aso Ankle X-lg","code_information":[{"code":"4304026","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Brace, Ankle, Swedo Xs","code_information":[{"code":"4302431","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302431","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Brace, Post-op Knee 2xl","code_information":[{"code":"4302578","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302578","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Cast- Stockinette 6 Synt","code_information":[{"code":"4301696","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301696","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Collection Set W/handle","code_information":[{"code":"4301238","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301238","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Dispsable Blades ( Sightpath )","code_information":[{"code":"4300946","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300946","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Prefilter Smoke Evacuator","code_information":[{"code":"4303067","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303067","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Tourn Cuff St 18 In (C)","code_information":[{"code":"4305054","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305054","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"99213 Level 3 Virtual Visit15 Min","code_information":[{"code":"3331703","type":"CDM"},{"code":"521","type":"RC"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Telehealth Originating Site Facility Fee Charge","code_information":[{"code":"4080100","type":"CDM"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Methylprednisolone(depomedrol) 80 Mg/ml Inj Susp 1 Ml [Gmh]c","code_information":[{"code":"4500812","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219157405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":50}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Norepinephrine 4 Mg/250 Ml-d5% Sol [Gmh]","code_information":[{"code":"4507123","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338011220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":50}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Succinylcholine 20 Mg/ml 10 Ml  Inj Sol [Gmh]","code_information":[{"code":"4502638","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710137702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":50}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Stratafix Monocryl 3-0","code_information":[{"code":"4301724","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301724","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":49}]}]},{"description":"Sodium Bicarbonate 8.4% Iv Sol 50meq / 50 Ml [Gmh]","code_information":[{"code":"4502560","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323008950","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":50}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Enoxaparin 30 Mg/0.3 Ml Sc Sol [Gmh]","code_information":[{"code":"4504046","type":"CDM"},{"code":"250","type":"RC"},{"code":"00075801310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":77,"gross_charge":80,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":50}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Naloxone 0.4  Soln [Gmh]","code_information":[{"code":"4501872","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":76,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":49}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Methergine 0.2mg (Methylergonovine) 1 Ml, Amp [Gmh]","code_information":[{"code":"4501735","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991014417","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":76,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":49}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Calcium Gluconate 1000mg/50ml Sol [Gmh]","code_information":[{"code":"4507139","type":"CDM"},{"code":"250","type":"RC"},{"code":"80830236202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":76,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":49}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Terbutaline 1 Mg/ml 1 Ml Inj Sol [Gmh]","code_information":[{"code":"4500440","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":76,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":49}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ceftriaxone 1 G/50 Ml-iso-osmotic Dextrose Sol [Gmh]","code_information":[{"code":"4507111","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264315311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":76,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":49}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Angiocath 16ga X 3.25 ( C )","code_information":[{"code":"4304111","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304111","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":76,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Centesis Disp Cath Needle","code_information":[{"code":"4303063","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303063","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":76,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Semi-rigid Curette 4mm","code_information":[{"code":"4301103","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301103","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":76,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Ethibond 0 #Cx41d","code_information":[{"code":"4302315","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302315","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":76,"gross_charge":79,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Sumatriptan 50. Mg Tab [Gmh]","code_information":[{"code":"4504027","type":"CDM"},{"code":"250","type":"RC"},{"code":"16252059199","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":75,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Methylprednisolone(solumedrol) 500 Mg Inj [Gmh]","code_information":[{"code":"4502951","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009075801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":75,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Triglycerides","code_information":[{"code":"3800615","type":"CDM"},{"code":"301","type":"RC"},{"code":"84478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":75,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Univ Abd/sac Support","code_information":[{"code":"4302381","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302381","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":48,"maximum":75,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48}]}]},{"description":"Dobutamine 1 Mg/ml-d5w Intravenous Solution [Gmh]","code_information":[{"code":"4500927","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338107302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":75,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Polidocanol Soln [Gmh]","code_information":[{"code":"4501062","type":"CDM"},{"code":"250","type":"RC"},{"code":"46783012152","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":75,"gross_charge":78,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ibuprofen 100 Mg/ml Sol 8 Ml [Gmh]","code_information":[{"code":"4501011","type":"CDM"},{"code":"250","type":"RC"},{"code":"66220028708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":48}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Abdominal Binder L/xl","code_information":[{"code":"4302382","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302382","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Accupap W/ Manometer","code_information":[{"code":"4302518","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302518","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Disp Active Cord","code_information":[{"code":"4308918","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308918","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Springwound Epidural Catheter","code_information":[{"code":"3500247","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500247","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Wrist W/thumb-sm (Right)","code_information":[{"code":"4308952","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308952","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Wrist W/thumb-med (Right)","code_information":[{"code":"4308953","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308953","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Isovue-m 300 15 Ml [Gmh]","code_information":[{"code":"3701005","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270141215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":48}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Wrist W/thumb-sm (Left)","code_information":[{"code":"4308949","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308949","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Wrist W/thumb-med (Left)","code_information":[{"code":"4308950","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308950","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Wrist W/thumb-lrg (Left)","code_information":[{"code":"4308951","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308951","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Wrist W/thumb-lrg (Right)","code_information":[{"code":"4308954","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308954","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Scopolamine 1 Mg/72 Hrs Transderm Er Film [Gmh]","code_information":[{"code":"4502856","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019055303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":48}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cefoxitin 1 G/50 Ml-iso-osmotic Dextrose Sol [Gmh]","code_information":[{"code":"4507129","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264312311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":48}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Oxacillin 2 G Pow [Gmh]","code_information":[{"code":"4507115","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012824","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":74,"gross_charge":77,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":48}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Sodium Bicarbonate 4.2%  5 Ml Sol [Gmh]","code_information":[{"code":"4506087","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323008305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":73,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Glucose 25% Soln [Gmh]","code_information":[{"code":"4500654","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409177510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":73,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Belly Bag 1000ml","code_information":[{"code":"4300370","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300370","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":73,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Double Pumping Kit (C)","code_information":[{"code":"4301131","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301131","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":73,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Iovera Gas Cartridge","code_information":[{"code":"4309137","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309137","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":73,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Knee Strap Xxl","code_information":[{"code":"4308981","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308981","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":73,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Tis-u-trap 9mm Rigid","code_information":[{"code":"4301187","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301187","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":73,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47}]}]},{"description":"Empagliflozin 25 Mg Tab [Gmh]","code_information":[{"code":"4507084","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597015337","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":73,"gross_charge":76,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ceftriaxone 500 Mg Inj [Gmh]","code_information":[{"code":"4502451","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679070201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":47}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Dextrose 50% Iv Sol 50 Ml [Gmh]","code_information":[{"code":"4500835","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":47}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"G0463 Psychiatrist Onsite Visit Charge","code_information":[{"code":"3331326","type":"CDM"},{"code":"914","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Specialty Telehealth Facility Fee","code_information":[{"code":"3331722","type":"CDM"},{"code":"510","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Bilirubin Total","code_information":[{"code":"3800140","type":"CDM"},{"code":"305","type":"RC"},{"code":"82247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Calcium Level","code_information":[{"code":"3800165","type":"CDM"},{"code":"301","type":"RC"},{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"3800120","type":"CDM"},{"code":"305","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"3800495","type":"CDM"},{"code":"305","type":"RC"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Yes- Pt Pre-employment Post Offer Exam Chargepre-employment Post Offer Exam Charge","code_information":[{"code":"4200145-GP","type":"CDM"},{"code":"424","type":"RC"},{"code":"97116","type":"CPT","modifier":"GP"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GP"],"minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Occupational Health Spirometry","code_information":[{"code":"4000053","type":"CDM"},{"code":"460","type":"RC"},{"code":"CP4000053","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Tru-wave Pressure Transducer","code_information":[{"code":"3500101","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500101","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Hydrocortisone Powder-inj [Gmh]","code_information":[{"code":"4501064","type":"CDM"},{"code":"250","type":"RC"},{"code":"37875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupivacaine-epinehrine 0.50%-1:200,000 (Marcaine/epi)(bupivacaine / Epi) [Gmh]","code_information":[{"code":"4502529","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046357","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":47}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Aminophylline 25 Mg/ml Iv Sol [Gmh]","code_information":[{"code":"4500146","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409592101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":47}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tetanus, Diphtheria Toxoids & Acellular Pertussis Vaccine (Tdap),","code_information":[{"code":"3334213","type":"CDM"},{"code":"636","type":"RC"},{"code":"90715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"6 In Coude Blunt Nerve Block Ndl","code_information":[{"code":"4304108","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304108","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":72,"gross_charge":75,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":46}]}]},{"description":"Etoposide 100 Mg Vial [Gmh]","code_information":[{"code":"4504043","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729011431","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":71,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":46}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Norepinephrine 1mg/ml 4ml  Soln [Gmh]","code_information":[{"code":"4503009","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121157607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":71,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":46}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Bill Cytopathology, Direct Smear","code_information":[{"code":"3800184","type":"CDM"},{"code":"300","type":"RC"},{"code":"88104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":71,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Flat Wound Drain 10mm","code_information":[{"code":"4300877","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300877","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":71,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Smartez 270ml 5ml ( C )","code_information":[{"code":"4400163","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400163","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":71,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Smartez Pump 270ml","code_information":[{"code":"4400146","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400146","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":71,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Phytonadione 1 Mg/0.5 Ml Inj Sol [Gmh]","code_information":[{"code":"4503274","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329124001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":71,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":46}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Vancomycin 1000mg/200 Ml Premix  Sol [Gmh]","code_information":[{"code":"4507070","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143947212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":71,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":46}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Medihoney 1.5 Oz","code_information":[{"code":"4300102","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300102","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":71,"gross_charge":74,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Empagliflozin 10 Mg Tab Ud {Gmh]","code_information":[{"code":"4507171","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597015237","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pedi Scd Sleeve Knee (C)","code_information":[{"code":"4308886","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308886","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Rh Charge","code_information":[{"code":"3800515","type":"CDM"},{"code":"302","type":"RC"},{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Consult, Pulmonologist","code_information":[{"code":"4000024","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"18fr Councill W/5ml","code_information":[{"code":"4308922","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308922","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"20fr Councill W/5ml","code_information":[{"code":"4308923","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308923","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"22fr Councill W5ml","code_information":[{"code":"4308924","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308924","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Adaptive Equip Kit (C)","code_information":[{"code":"4300125","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300125","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Casting, Splint 5 Xfast","code_information":[{"code":"4300348","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300348","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Colostomy Kit 2 1/4","code_information":[{"code":"4300504","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300504","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Tourn Cuff St 12 In","code_information":[{"code":"4305053","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305053","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}]},{"description":"Nitroglycerin 25 Mg/250 Ml-d5w Iv Sol [Gmh]","code_information":[{"code":"4501945","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338104702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hepatitis A Peds/adol Vaccine 2 Dose Sched Charge","code_information":[{"code":"3331064","type":"CDM"},{"code":"636","type":"RC"},{"code":"90633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":70,"gross_charge":73,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":45}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"90471 Clinic Immunization Admin 1st Vaccine","code_information":[{"code":"3332241","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":69,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Allevyn Sacrum 7x7","code_information":[{"code":"4300695","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300695","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":69,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Ez Stabilizer","code_information":[{"code":"4301134","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301134","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":69,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Hip Abduction Pillow Univ","code_information":[{"code":"4300111","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300111","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":69,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"K Wire 1.6mm Treaded 292.16","code_information":[{"code":"4300010","type":"CDM"},{"code":"278","type":"RC"},{"code":"CP4300010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":69,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Knee Support Osgood Sl Xl","code_information":[{"code":"4302493","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302493","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":69,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Knee Support Osgood Sl Lg","code_information":[{"code":"4302494","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302494","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":69,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Fluconazole 100 Mg Tab [Gmh]","code_information":[{"code":"4500874","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084072801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":69,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":45}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Jumbo Biopsy Forcep ( C )","code_information":[{"code":"4300282","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300282","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":69,"gross_charge":72,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Cephalexin 125 Mg/5 Ml Oral Liq [Gmh]","code_information":[{"code":"4500596","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093417573","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":68,"gross_charge":71,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Hetastarch 60 Mg/ml-ns Iv Sol 500 Ml [Gmh]","code_information":[{"code":"4504251","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264196510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":68,"gross_charge":71,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Isovue-300 50 Ml Sol [Gmh]","code_information":[{"code":"3761003","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270131530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":68,"gross_charge":71,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Bupivacaine-epinephrine 0.25%-1:200,000 Sol [Gmh]","code_information":[{"code":"4503511","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046157","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":68,"gross_charge":71,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Exofin Adhesive","code_information":[{"code":"4301770","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301770","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":68,"gross_charge":71,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Uterine Suction Currette 8mm","code_information":[{"code":"4301080","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301080","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":68,"gross_charge":71,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":44}]}]},{"description":"Oxytocin 30 Units/500 Ml-nacl 0.9% Sol [Gmh]","code_information":[{"code":"4507157","type":"CDM"},{"code":"250","type":"RC"},{"code":"71266510301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":30,"type":"UN"}},{"description":"Vancomycin 1. Gm Powder-inj [Gmh]","code_information":[{"code":"4502981","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409653501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Tunnel Dressing (C)","code_information":[{"code":"4300851","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Aripiprazole 10 Mg Tab [Gmh]","code_information":[{"code":"4507181","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148000813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Consult, Vascular","code_information":[{"code":"4000030","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Bun","code_information":[{"code":"3800160","type":"CDM"},{"code":"301","type":"RC"},{"code":"84520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Bilirubin Direct","code_information":[{"code":"3800145","type":"CDM"},{"code":"301","type":"RC"},{"code":"82248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Cholesterol High Density Lipid","code_information":[{"code":"3800320","type":"CDM"},{"code":"301","type":"RC"},{"code":"83718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Influenza A","code_information":[{"code":"3800294","type":"CDM"},{"code":"306","type":"RC"},{"code":"87276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Influenza B","code_information":[{"code":"3800284","type":"CDM"},{"code":"306","type":"RC"},{"code":"87275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Urinalysis test","code_information":[{"code":"3800641","type":"CDM"},{"code":"307","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Potassium Level","code_information":[{"code":"3800460","type":"CDM"},{"code":"301","type":"RC"},{"code":"84132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Retic Count 1","code_information":[{"code":"3800510","type":"CDM"},{"code":"305","type":"RC"},{"code":"85044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Sedimentation Rate","code_information":[{"code":"3805075","type":"CDM"},{"code":"305","type":"RC"},{"code":"85651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Transcutaneous Bilirubin, Poc","code_information":[{"code":"3806137","type":"CDM"},{"code":"300","type":"RC"},{"code":"88720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Urinalysis test using microscope","code_information":[{"code":"3800630","type":"CDM"},{"code":"307","type":"RC"},{"code":"81001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Wellness Screening Pe","code_information":[{"code":"3801062","type":"CDM"},{"code":"300","type":"RC"},{"code":"CP3801062","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Ot Power Chair Eval Charge","code_information":[{"code":"4230055-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97542","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"29240 Pt Strapping Shoulder Charge","code_information":[{"code":"4200184","type":"CDM"},{"code":"420","type":"RC"},{"code":"29240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Mammography, screening, bilateral","code_information":[{"code":"3720015-TC","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"CPT","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Ob- Pack, Delivery (Disp) ( C )","code_information":[{"code":"4301056","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301056","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Vicryl 1 J741d","code_information":[{"code":"4302568","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302568","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Water Trap Neonate","code_information":[{"code":"4304030","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304030","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"99422 11-20min Virtual Visit","code_information":[{"code":"3331698","type":"CDM"},{"code":"521","type":"RC"},{"code":"99422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Blood test, clotting time","code_information":[{"code":"112212009-QW","type":"CDM"},{"code":"305","type":"RC"},{"code":"85610","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43}]}]},{"description":"Triamcinolone/moxifloxacin 15/1 Mg/ml [Gmh]","code_information":[{"code":"4505072","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999999987","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":67,"gross_charge":70,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ondansetron 4 Mg Dis Tab [Gmh]","code_information":[{"code":"4504029","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462015713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":66,"gross_charge":69,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":43}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Morgan Lens Del Set (C)","code_information":[{"code":"4300100","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":66,"gross_charge":69,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Ipv Inactivated Poliovirus Vaccine Poc","code_information":[{"code":"3331050","type":"CDM"},{"code":"636","type":"RC"},{"code":"90713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":66,"gross_charge":69,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Polyethylene Glycol 3350 With Electrolytes Powder-recon [Gmh]","code_information":[{"code":"4502020","type":"CDM"},{"code":"250","type":"RC"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":66,"gross_charge":69,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":43}]}],"drug_information":{"unit":3350,"type":"EA"}},{"description":"Potassium Chloride 20 Meq/15 Ml Liq [Gmh]","code_information":[{"code":"4502341","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689004730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Rivaroxaban 10 Mg Tab [Gmh]","code_information":[{"code":"4503017","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Linaclotide 72 Mcg Cap [Gmh]","code_information":[{"code":"4506013","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456120330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":72,"type":"ME"}},{"description":"22fr Coude W/5ml","code_information":[{"code":"4302015","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302015","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"3m Sensatrac Pad (C)","code_information":[{"code":"4302584","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302584","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Cat Tourniquet","code_information":[{"code":"4305061","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305061","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Vicryl 6-0 J570g","code_information":[{"code":"4302293","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302293","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Synvisc Per 1mg Intra Injection","code_information":[{"code":"3331049-TB","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS","modifier":"TB"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TB"],"minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Hydrocortisone 25 Mg Supp [Gmh]","code_information":[{"code":"4501287","type":"CDM"},{"code":"250","type":"RC"},{"code":"00713050312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Casting, Splint 4 Xfast","code_information":[{"code":"4300347","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300347","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":65,"gross_charge":68,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":42}]}]},{"description":"Esmolol 10 Mg/ml 10 Ml Sol [Gmh]","code_information":[{"code":"4504049","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323065210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":42}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diabetic Education Initial","code_information":[{"code":"4000035","type":"CDM"},{"code":"942","type":"RC"},{"code":"CP4000035","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Arthroscopy Dual Irrig Adapter","code_information":[{"code":"4300223","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300223","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Ethibond O Cx21d","code_information":[{"code":"4302328","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302328","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Hot Biopsy Forcep","code_information":[{"code":"4308901","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308901","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":64,"gross_charge":67,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Protamine 50.  Soln [Gmh]","code_information":[{"code":"4502325","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Apep Pep Therapy System","code_information":[{"code":"4302517","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302517","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Babywire .012 X 18","code_information":[{"code":"4309007","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Cold/hot Snare ( Olympus ) ( C )","code_information":[{"code":"4300885","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300885","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Ultra-pro Ii Needle Guide","code_information":[{"code":"4304022","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP4304022","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Universal Cannula 5.5mm Gray/smooth","code_information":[{"code":"4308998","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308998","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":41,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41}]}]},{"description":"Methotrexate 25 Mg/ml 2ml Sol [Gmh]","code_information":[{"code":"4506043","type":"CDM"},{"code":"250","type":"RC"},{"code":"61703035038","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":63,"gross_charge":66,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Personal Cgm Start Up / Training","code_information":[{"code":"33370003","type":"CDM"},{"code":"761","type":"RC"},{"code":"95249","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Albumin Level","code_information":[{"code":"3800025","type":"CDM"},{"code":"301","type":"RC"},{"code":"82040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Pds 0 Z990g","code_information":[{"code":"4301720","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301720","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"99212 Level 2 Virtual Visit10 Min","code_information":[{"code":"3331702","type":"CDM"},{"code":"521","type":"RC"},{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Epinephrine 1 Mg/ml 1 Ml  Inj Sol [Gmh]","code_information":[{"code":"4501030","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023015925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Head And Chin Straps (C)","code_information":[{"code":"4300263","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300263","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":62,"gross_charge":65,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":40}]}]},{"description":"Cefazolin 2 G/50 Ml Sol [Gmh]","code_information":[{"code":"4507107","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264310511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":40}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Bill Breath Alcohol Test","code_information":[{"code":"3809998","type":"CDM"},{"code":"309","type":"RC"},{"code":"CP3809998","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Epidural Microbore Tubing","code_information":[{"code":"3500246","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500246","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Ethibond 0 Cx45d","code_information":[{"code":"4301124","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301124","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Octyl Liquiband","code_information":[{"code":"4301760","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301760","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Veress Needle","code_information":[{"code":"4300959","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300959","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Fentanyl 25 Mcg/hr Transderm Er Film [Gmh]","code_information":[{"code":"4500985","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042447","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":40}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Epinephrine 1 Mg/ml Sol Pf [Gmh]","code_information":[{"code":"4506070","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":40}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ampicillin-sulbactam 3 G Inj [Gmh]","code_information":[{"code":"4502940","type":"CDM"},{"code":"250","type":"RC"},{"code":"00049001483","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":61,"gross_charge":64,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":40}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Betamethasone-clotrimazole Topical 0.05%-1% Cre 15 Gm [Gmh]","code_information":[{"code":"4501635","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Neptune Manifold ( C )","code_information":[{"code":"4306002","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Perifix Epidural Tray","code_information":[{"code":"3500213","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500213","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Nurolon 4-0 C554d","code_information":[{"code":"4302320","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302320","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":60,"gross_charge":63,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":39}]}]},{"description":"Inhalation 1000ml W/ Adapter (C)","code_information":[{"code":"4300830","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300830","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":60,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Celiac Disease Reflexive Cascade (Arup Via Rps)","code_information":[{"code":"3806192","type":"CDM"},{"code":"300","type":"RC"},{"code":"86364","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":60,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Algo Hearing Screen Pak ( C )","code_information":[{"code":"4302062","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302062","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":60,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Chromic 4-0 1654g","code_information":[{"code":"4302234","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302234","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":60,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Ob Pudendal Tray","code_information":[{"code":"4304181","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304181","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":60,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Purewick Cath (C)","code_information":[{"code":"4302004","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":60,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Walkmed Pump Tubing Set","code_information":[{"code":"4400115","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400115","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":60,"gross_charge":62,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":38}]}]},{"description":"Alendronate 70 Mg Tab [Gmh]","code_information":[{"code":"4503535","type":"CDM"},{"code":"250","type":"RC"},{"code":"76439013104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":59,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":38}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Sulfamethoxazole-trimethoprim 200 Mg-40 Mg/5 Ml Oral Suspension [Gmh]","code_information":[{"code":"4506056","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121085340","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":59,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":38}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Gmh Ma Cad Diagnostic","code_information":[{"code":"3720010-TC","type":"CDM"},{"code":"401","type":"RC"},{"code":"CP3720010TC","type":"LOCAL","modifier":"TC"}],"standard_charges":[{"setting":"outpatient","modifier_code":["TC"],"minimum":37,"maximum":59,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Smartez Pump 100ml (C)","code_information":[{"code":"4400129","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400129","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":59,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Suction- Gastric Lavage","code_information":[{"code":"4301714","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301714","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":59,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Fentanyl 12 Mcg/hr Td Film, Er [Gmh]","code_information":[{"code":"4501313","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378911998","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":59,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":38}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Tetanus-diphtheria Toxoids 7 Yrs And Older Poc","code_information":[{"code":"1110714","type":"CDM"},{"code":"636","type":"RC"},{"code":"90714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":59,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ropivacaine 0.2% Inj Sol 20 Ml [Gmh]","code_information":[{"code":"4500615","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150019520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":59,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":38}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Vancomycin 750 Mg/150 Ml Premix  Sol [Gmh]","code_information":[{"code":"4507072","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143946812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":59,"gross_charge":61,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":38}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"G0463 Doctor 1st Visit (Spine)","code_information":[{"code":"3657000","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"G0463 Doctor Recheck (Spine)","code_information":[{"code":"3658000","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"G0463 Doctor Check 1st Visit","code_information":[{"code":"3651000","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"G0463 Doctor Recheck Visit","code_information":[{"code":"3652000","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Bill Insurance Collection Of Urine And/or Blood","code_information":[{"code":"3806133","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Glucose, Fingerstick","code_information":[{"code":"3801065","type":"CDM"},{"code":"301","type":"RC"},{"code":"82948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Hematocrit","code_information":[{"code":"3800325","type":"CDM"},{"code":"305","type":"RC"},{"code":"85014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Blood Glucose Monitoring Poc","code_information":[{"code":"112212003","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Iv Sol- 1000cc 5% Dlr","code_information":[{"code":"4401001","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4401001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol- 1000cc Lr","code_information":[{"code":"4401002","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4401002","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol- 1000cc D 1/2 ( 0.45% )","code_information":[{"code":"4401004","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4401004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol- 1000cc .45%nacl","code_information":[{"code":"4401005","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4401005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol- 1000 D5/9%nacl","code_information":[{"code":"4401007","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4401007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol- 1000cc 9% Nacl","code_information":[{"code":"4401008","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4401008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Monofocal Iols J&j Tecnis Dcb00 Pcb00 Preload ( Sightpath )","code_information":[{"code":"4300957","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300957","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Pencan Spinal Tray","code_information":[{"code":"3500231","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500231","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Silver Alginate 4x4 ( C )","code_information":[{"code":"4300767","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300767","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Unna Boot (C)","code_information":[{"code":"4301926","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301926","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Dextrose 5% In Water Iv Sol 1000 Ml [Gmh]","code_information":[{"code":"4401006","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990792209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Dextrose 5% With 0.2% Nacl Iv Sol 1000 Ml [Gmh]","code_information":[{"code":"4401003","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338007704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Ketamine 100 Mg/ml Inj Sol 5 Ml [Gmh]","code_information":[{"code":"4501010","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023011510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluorouracil 50 Mg/ml 10 Ml Sol [Gmh]","code_information":[{"code":"4506002","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703301513","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Potocky Needle 27ga","code_information":[{"code":"4303065","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303065","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Urocatcher Bag","code_information":[{"code":"4300702","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300702","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Weighted Feeding Tube 10fr","code_information":[{"code":"4300675","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300675","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":58,"gross_charge":60,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":37}]}]},{"description":"Misc. Item Pt","code_information":[{"code":"4309900","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309900","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":57,"gross_charge":59,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Cefazolin 1 G/50 Ml-iso-osmotic Dextrose Sol [Gmh]","code_information":[{"code":"4507108","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264310311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":57,"gross_charge":59,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":37}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Trace Elements With Selenium 10 Mcg-1 Mg-0.5 Mg-60 Mcg-5 Mg/ml Sol [Gmh]","code_information":[{"code":"4505080","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517820125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":57,"gross_charge":59,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":37}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Otomed Suction Tubing","code_information":[{"code":"4305522","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305522","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":57,"gross_charge":59,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Glycophos Sterile Concentrate 20ml Vial [Gmh]","code_information":[{"code":"4501112","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323024120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":57,"gross_charge":59,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":37}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Ureteral Cath 5 Fr Open-end","code_information":[{"code":"4300409","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300409","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":57,"gross_charge":59,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Pfizerpen 5million Units (Penicillin G Potassiun) Injection [Gmh]","code_information":[{"code":"4504016","type":"CDM"},{"code":"250","type":"RC"},{"code":"00049042010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":56,"gross_charge":58,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":5,"type":"UN"}},{"description":"Pump Reservoir 150ml","code_information":[{"code":"4400114","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400114","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":56,"gross_charge":58,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"8fr Salem Sump","code_information":[{"code":"4301746","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301746","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":56,"gross_charge":58,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":36}]}]},{"description":"Lidocaine 0.5% Pf 50 Ml Inj Sol [Gmh]","code_information":[{"code":"4503110","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049157","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":56,"gross_charge":58,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Epinephrine 0.1 Mg/ml Inj Sol [Gmh]","code_information":[{"code":"4501034","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":56,"gross_charge":58,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Furosemide 10 Mg/ml 4 Ml Inj Sol [Gmh]","code_information":[{"code":"4501145","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323028026","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Anes- Blade Disp","code_information":[{"code":"3500341","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500341","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Blade Electrode Coated Insulated 70mm ( C )","code_information":[{"code":"4301066","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301066","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Coated Blade Electrode 165mm","code_information":[{"code":"4301075","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301075","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Cytology Brush","code_information":[{"code":"4300290","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300290","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"E-sep Needle Electrode 70mm","code_information":[{"code":"4301060","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301060","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Full Hdl Side Port Knife","code_information":[{"code":"4300432","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300432","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35}]}]},{"description":"Pancrelipase 40,000 Units-126,000 Units-168,000 Units Cap [Gmh]","code_information":[{"code":"4507132","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":40000,"type":"UN"}},{"description":"Levofloxacin 500 Mg Tab [Gmh]","code_information":[{"code":"4501597","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084048201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Dopamine 400 Mg / 250 Ml D5w  [Gmh]","code_information":[{"code":"4500950","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338100702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":55,"gross_charge":57,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Athletic Support Xlg (C)","code_information":[{"code":"4300212","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300212","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"250 Nacl .9% Pvc Free","code_information":[{"code":"4401010","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4401010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"500 Cc Nacl .9% Pvc Free","code_information":[{"code":"4400109","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4400109","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv 0.45% Sod Chl 500ml","code_information":[{"code":"4400506","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4400506","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol- 250 Dex 10%","code_information":[{"code":"4400255","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4400255","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol- 500cc Dex 5%","code_information":[{"code":"4400502","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4400502","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol- 500cc 9% Nacl","code_information":[{"code":"4400503","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4400503","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol- 50cc 9% Nacl","code_information":[{"code":"4400051","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4400051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Iv Sol-100cc D5","code_information":[{"code":"4400102","type":"CDM"},{"code":"636","type":"RC"},{"code":"CP4400102","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ndl Stim Ultra 20 X 4 (Use 3500325 Instead)","code_information":[{"code":"3500324","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500324","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Sterile H20 Inhalation 2000ml","code_information":[{"code":"4401013","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4401013","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Tourn Cuff 34 Purple (C)","code_information":[{"code":"4305044","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305044","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Tourn Cuff 44 Nb","code_information":[{"code":"4305045","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305045","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Tourn Cuff 12 Green (C)","code_information":[{"code":"4305040","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Tourn Cuff 18 Red (C)","code_information":[{"code":"4305041","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305041","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Tourn Cuff 24 Yellow (C)","code_information":[{"code":"4305042","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305042","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Tourn Cuff 30 Rb","code_information":[{"code":"4305043","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305043","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Dtap Diphtheria/pertussis, Acellular/tetanus Vaccine Dtap Under 7 Yrs Poc","code_information":[{"code":"3334207","type":"CDM"},{"code":"636","type":"RC"},{"code":"90700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Silver Sulfadiazine Top 1% 20 Gm Crm [Gmh]","code_information":[{"code":"4502521","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877012420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":54,"gross_charge":56,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":35}]}],"drug_information":{"unit":20,"type":"GR"}},{"description":"Lidocaine 1% Preservative-free 30 Ml Sol [Gmh]","code_information":[{"code":"4506051","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049237","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Aminophylline 25 Mg/ml 20ml Sol [Gmh]","code_information":[{"code":"4507049","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409592201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Diabetes Outpt Self Management Training, Individual (Medicare)","code_information":[{"code":"3331957","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Urinalysis test","code_information":[{"code":"3800546","type":"CDM"},{"code":"307","type":"RC"},{"code":"81003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"90472 Each Additional Immunization Admin Charge.","code_information":[{"code":"3105064","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Aerochamber Pedi","code_information":[{"code":"4302524","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302524","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Anes- Soda Sorb Soda Lime","code_information":[{"code":"3500239","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500239","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Collar Button Vt Pc Si 1.27mm ( C )","code_information":[{"code":"4305519","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305519","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Ethibond 2-0 Cx42d","code_information":[{"code":"4302296","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302296","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Vicryl 3-0 J864d","code_information":[{"code":"4300287","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300287","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Blood Glucose Monitoring Poc Brady","code_information":[{"code":"3331687-QW","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Hemocult Poc Brady","code_information":[{"code":"3331685-QW","type":"CDM"},{"code":"300","type":"RC"},{"code":"82274","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34}]}]},{"description":"Oseltamivir 75 Mg Cap [Gmh]","code_information":[{"code":"4503756","type":"CDM"},{"code":"250","type":"RC"},{"code":"00004080085","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":53,"gross_charge":55,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Labetalol 5 Mg/ml 20ml Vial Sol [Gmh]","code_information":[{"code":"4506038","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611073401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Coban 2 Lite Compression System ( C )","code_information":[{"code":"4300776","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300776","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Sport Ankle Splint Sm","code_information":[{"code":"4301642","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301642","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"S9443-breastfeeding Instruction Session (Ppp Services)","code_information":[{"code":"33370009","type":"CDM"},{"code":"761","type":"RC"},{"code":"S9443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Neomycin-polymyxin B Sulfate Top Sol 1 Ml [Gmh]","code_information":[{"code":"4501883","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822120102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Adult Glasscock Ear Dressing","code_information":[{"code":"4305523","type":"CDM"},{"code":"CP4305523","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Cast- Stockinette 4 Synt","code_information":[{"code":"4301694","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301694","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Endogator","code_information":[{"code":"4301198","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301198","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Ethibond 0 Cx31d","code_information":[{"code":"4302340","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302340","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Ethibond 1 Cx30d","code_information":[{"code":"4302312","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302312","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Pediatric Glasscock Ear Dressing","code_information":[{"code":"4305524","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305524","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Univ Surestep Cath Tray","code_information":[{"code":"4300450","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300450","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Cath 20fr 2-way W/5ml","code_information":[{"code":"4302020","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Chloroprocaine 3% Preservative-free Sol [Gmh]","code_information":[{"code":"4504082","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323047827","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Atropine 0.4 Mg/ml Sol [Gmh]","code_information":[{"code":"4507095","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517100425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Bupivacaine 0.5% Inj Sol 50 Ml [Gmh]","code_information":[{"code":"4502536","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046757","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":52,"gross_charge":54,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Bacitracin 50000 Units Pow [Gmh]","code_information":[{"code":"4506019","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009024101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":50000,"type":"UN"}},{"description":"Clindamycin 600 Mg/50 Ml-nacl 0.9% Sol [Gmh]","code_information":[{"code":"4507209","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338954924","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Oxymetazoline Nasal 0.05% Spr 30 Ml[gmh]","code_information":[{"code":"4506071","type":"CDM"},{"code":"250","type":"RC"},{"code":"41100081125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Lmb Finger Splint","code_information":[{"code":"4308102","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308102","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Promethazine 25. Mg Supp [Gmh]","code_information":[{"code":"4502175","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802075930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bss 15ml","code_information":[{"code":"4300361","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300361","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Premi-probe 3 (C)","code_information":[{"code":"4301040","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301040","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"69209 Ear Irrigation W/o Instruments","code_information":[{"code":"3332024","type":"CDM"},{"code":"450","type":"RC"},{"code":"69209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Armboard, Iv Adult","code_information":[{"code":"4400106","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400106","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Neonat/adult Spo2 Sensor ( C )","code_information":[{"code":"4301096","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301096","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Methylprednisolone(solumedrol) Vial 125mg/2ml [Gmh]","code_information":[{"code":"4502570","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009004704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Nystatin Top 100,000 Units/g Crm [Gmh]","code_information":[{"code":"4502027","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672128901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":100000,"type":"UN"}},{"description":"Mepivacaine 2% Pf Inj Sol 20 Ml [Gmh]","code_information":[{"code":"4509004","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323029427","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Iv Sol-500ml 3% Sod Chl","code_information":[{"code":"4400108","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4400108","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Ndl Stim 20 X 4 Ext Set ( C )","code_information":[{"code":"3500325","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500325","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}]},{"description":"Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine (Dtap), Under 7 Years, Im","code_information":[{"code":"3332381","type":"CDM"},{"code":"636","type":"RC"},{"code":"90700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":51,"gross_charge":53,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Sodium Bicarbonate 4.2% Infant 5meq (0.5meq/ml) [Gmh]","code_information":[{"code":"4508959","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409553434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":42,"type":"EA"}},{"description":"Cast- Stockinette 4 Cotton","code_information":[{"code":"4301698","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301698","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Hemoglobin","code_information":[{"code":"3800330","type":"CDM"},{"code":"305","type":"RC"},{"code":"85018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"1000ml Evac Container ( C )","code_information":[{"code":"4400126","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400126","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Cast Supplies, Short Arm Splint, Adult (11 Years +), Fiberglass","code_information":[{"code":"3335018","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3335018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Esmark 6 ( C )","code_information":[{"code":"4300636","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300636","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Ndl 22x5 W/intro","code_information":[{"code":"4305514","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305514","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Profore Compression System","code_information":[{"code":"4301927","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301927","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Thoracentesis Tray","code_information":[{"code":"4303061","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303061","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32}]}]},{"description":"Calcium Chloride 100 Mg/ml 10 Ml Inj Sol [Gmh]","code_information":[{"code":"4500515","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":50,"gross_charge":52,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Coflex Tlc Zinc Lite (C)","code_information":[{"code":"4301832","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Thiamine 100 Mg/ml Inj Sol [Gmh]","code_information":[{"code":"4503257","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001326","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":32}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Angled I/a Tip","code_information":[{"code":"4300323","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300323","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Cath 20fr 3-way W/30ml","code_information":[{"code":"4308925","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308925","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Ndl Stim Ultra 22x1 3/8","code_information":[{"code":"4304004","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Osgood Schlat Sleevesm","code_information":[{"code":"4308935","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308935","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Osgood Schlat Sleevemed","code_information":[{"code":"4308936","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308936","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Osgood Schlat Sleevelrg","code_information":[{"code":"4308937","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308937","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Osgood Schlat Sleevexl","code_information":[{"code":"4308938","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308938","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Timolol Ophthalmic Maleate 0.5% Sol [Gmh]","code_information":[{"code":"4507214","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":32}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Epinephrine-lidocaine 1:200,000-2% Preservative-free Sol[gmh]","code_information":[{"code":"4502023","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048917","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atropine 0.1 Mg/ml 10 Ml  Sol [Gmh]","code_information":[{"code":"4507152","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409163010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":32}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Beach Chair Disp. Kit","code_information":[{"code":"4300271","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300271","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Hydrofera 4x4 ( C )","code_information":[{"code":"4300824","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300824","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Thorax Pad Disp.","code_information":[{"code":"4300272","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300272","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Abdominal Binder M/l","code_information":[{"code":"4302380","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302380","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Spiro Connector (C)","code_information":[{"code":"4400151","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400151","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Chronic Care Subsequent 20 Minutes Of Care Provided By Clinical Staff","code_information":[{"code":"33370002","type":"CDM"},{"code":"761","type":"RC"},{"code":"99439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":49,"gross_charge":51,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Oseltamivir 30 Mg Cap [Gmh]","code_information":[{"code":"4505078","type":"CDM"},{"code":"250","type":"RC"},{"code":"00004080285","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Creat Urine","code_information":[{"code":"3800266","type":"CDM"},{"code":"301","type":"RC"},{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Occult Blood Screen 5","code_information":[{"code":"3800423","type":"CDM"},{"code":"307","type":"RC"},{"code":"82270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Medical Nutrition Education Follow Up","code_information":[{"code":"3655001","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Blood Glucose Monitoring Poc","code_information":[{"code":"4304069","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304069","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"4.5 Coude Blunt Nerve","code_information":[{"code":"4304106","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304106","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Child Crutches 4'0- 4'6","code_information":[{"code":"4302473","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302473","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Peripheral Temp Probe","code_information":[{"code":"4301048","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301048","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Single Use Splint 5 X 30","code_information":[{"code":"4300544","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300544","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Suction Coagulator 12fr","code_information":[{"code":"4301718","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301718","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Warming Flex Gown Std (C)","code_information":[{"code":"4301999","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"99211 Level 1 Virtual Visit5 Min","code_information":[{"code":"3331701","type":"CDM"},{"code":"521","type":"RC"},{"code":"99211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"98940 Chiropractic Manipulative Treatment (Cmt); Spinal, 1-2 Regions.","code_information":[{"code":"3331736","type":"CDM"},{"code":"521","type":"RC"},{"code":"98940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Bupivacaine 0.25% Inj Sol 50 Ml [Gmh]","code_information":[{"code":"4502522","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143932810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Lactated Ringers Injection Sol 500 Ml [Gmh]","code_information":[{"code":"4400504","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338011703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"Ciprofloxacin Ophthalmic 0.3% Soln [Gmh]","code_information":[{"code":"4504011","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383028202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Peri Foam Wash (C)","code_information":[{"code":"4301177","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301177","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Laparotomy Pack ( C )","code_information":[{"code":"4300937","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300937","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":48,"gross_charge":50,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":31}]}]},{"description":"Etomidate 2 Mg/ml Sol 10ml Vial [Gmh]","code_information":[{"code":"4501017","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266014610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":47,"gross_charge":49,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ndl Stim Ultra 22x2","code_information":[{"code":"4304043","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304043","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":47,"gross_charge":49,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Famotidine 20 Mg/50 Ml Iv Sol [Gmh]","code_information":[{"code":"4501314","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338519741","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":47,"gross_charge":49,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Head And Neck Pack (C)","code_information":[{"code":"4301115","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301115","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":47,"gross_charge":49,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":30}]}]},{"description":"Tubersol 5tu/0.1ml (10 Test  Vial  1ml) Tb (Refrigerator Door) [Gmh]","code_information":[{"code":"4502674","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":30}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Triamcinolone Acetonide 40 Mg/ml 1 Ml Inj Susp [Gmh]","code_information":[{"code":"4502866","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003029305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":30}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Clo Test 1","code_information":[{"code":"3800258","type":"CDM"},{"code":"306","type":"RC"},{"code":"87339","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Scd Stockings Knee High Md ( C )","code_information":[{"code":"4308878","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308878","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Splint, Cockup, R Xxsm","code_information":[{"code":"4302395","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302395","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Splint, Cockup, R Med","code_information":[{"code":"4302398","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302398","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Splint, Cockup, R Xlrg","code_information":[{"code":"4302400","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302400","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Splint, Cockup, L Xxsm","code_information":[{"code":"4302401","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302401","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Splint, Cockup, L Sm","code_information":[{"code":"4302403","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302403","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Splint, Cockup, L Med","code_information":[{"code":"4302404","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302404","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Splint, Cockup, L Lrg","code_information":[{"code":"4302405","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302405","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Splint, Cockup, L Xlrg","code_information":[{"code":"4302406","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302406","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Tkr Footrest Foam Black Pad (C)","code_information":[{"code":"4300273","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300273","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"20-minute Interactive Rpm Services","code_information":[{"code":"33370012","type":"CDM"},{"code":"761","type":"RC"},{"code":"99457","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"16fr Coude W/5ml Silicone (C)","code_information":[{"code":"4300410","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300410","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Trilogy Circuit ( Order As 989805662101)","code_information":[{"code":"3500297","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500297","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Azithromycin 500 Mg Iv Inj [Gmh]","code_information":[{"code":"4503165","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":46,"gross_charge":48,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":30}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Flu Vaccine Split 3 Yrs And Above Im Poc","code_information":[{"code":"3332243","type":"CDM"},{"code":"636","type":"RC"},{"code":"90656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"14fr Coude W/5ml (C)","code_information":[{"code":"4300404","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300404","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"16fr Coude W/30ml","code_information":[{"code":"4300411","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300411","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"18fr Coude W/5ml (C)","code_information":[{"code":"4300415","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300415","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Cautery Tip Insulated","code_information":[{"code":"4300420","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300420","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Chest Tube 32fr","code_information":[{"code":"4300488","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300488","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Chest Tube 36fr","code_information":[{"code":"4300489","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300489","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Cooper Dual Dispersive Electrode W/out Connector","code_information":[{"code":"4303074","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303074","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Cooper Hand Switch-operated Cautery Pencil","code_information":[{"code":"4303076","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303076","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Endo Smartcap","code_information":[{"code":"4301196","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301196","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Ent Gel Foam","code_information":[{"code":"4300603","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300603","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Splint, Cockup, R Lrg","code_information":[{"code":"4302399","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302399","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Hepatitis B Vaccine, Pediatric 3 Dose Sched Poc","code_information":[{"code":"3331053","type":"CDM"},{"code":"636","type":"RC"},{"code":"90744","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Influenza Virus Vaccine, Splie Virus, Preservative Free, For Children 6-35 Months Of Age, Im Poc (In","code_information":[{"code":"3331065","type":"CDM"},{"code":"636","type":"RC"},{"code":"90656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Q2037 Influenza Medicare","code_information":[{"code":"3334132","type":"CDM"},{"code":"636","type":"RC"},{"code":"90656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Fluconazole 200 Mg/100 Ml-ns Iv Sol [Gmh]","code_information":[{"code":"4500876","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Vancomycin 500 Mg/100 Ml Sol Premix Soln [Gmh]","code_information":[{"code":"4507071","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143947112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Disp 5 Pc Aws Valve Set (C)","code_information":[{"code":"4300170","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300170","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29}]}]},{"description":"Heparin 50 Units/ml-nacl 0.45% Sol [Gmh]","code_information":[{"code":"4506068","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409315020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":45,"gross_charge":47,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":50,"type":"UN"}},{"description":"Ceftazidime 1 Gm Inj [Gmh]","code_information":[{"code":"4509001","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781317796","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":29}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Bronchoscopy Suction Valve Maj-209","code_information":[{"code":"4300569","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300569","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Cast- Stockinette 3 Synt","code_information":[{"code":"4301693","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301693","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Chg Prep Kit","code_information":[{"code":"4301037","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Gortex Cv-2 Th-26","code_information":[{"code":"4302357","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302357","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Merit Drainage Bag","code_information":[{"code":"4300472","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300472","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Nasal Packing, 4.5cm","code_information":[{"code":"4300994","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300994","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Powerloc 20g X 1.5","code_information":[{"code":"4305515","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305515","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Shoe, Surgical Xxlg Men","code_information":[{"code":"4302462","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302462","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Sling & Swathe (Univ)","code_information":[{"code":"4302488","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302488","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Splint, Cockup, R Xsm","code_information":[{"code":"4302396","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302396","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Splint, Cockup, R Sm","code_information":[{"code":"4302397","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302397","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Splint, Cockup, L Xsm","code_information":[{"code":"4302402","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302402","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Vented Paclitaxel Set (C)","code_information":[{"code":"4400174","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400174","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Skin Staplermini (C)","code_information":[{"code":"4301281","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301281","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Glycopyrrolate 0.2 Mg/ml 1 Ml Inj Sol [Gmh]","code_information":[{"code":"4502001","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700016525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":29}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Silk 6-0 639g","code_information":[{"code":"4302267","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302267","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Influenza Split Virus Vaccine, Inactivated (Influenza Vaccine)","code_information":[{"code":"3332372","type":"CDM"},{"code":"636","type":"RC"},{"code":"90656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":44,"gross_charge":46,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Dextrose 5% With 0.45% Nacl And Kcl 40 Meq/l Iv Sol 1000 Ml [Gmh]","code_information":[{"code":"4501163","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338067504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Sodium Chloride 0.9% With Kcl 20 Meq/l Soln [Gmh]","code_information":[{"code":"4500144","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338069104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":9,"type":"UN"}},{"description":"Chest Tube 24fr (C)","code_information":[{"code":"4300486","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300486","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Iv Guard Adult","code_information":[{"code":"4400110","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400110","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Iv Sol- 100cc .45% Nacl","code_information":[{"code":"4400103","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4400103","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Loop Electrode 10mm","code_information":[{"code":"4301631","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301631","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Loop Electrode 20mm X 15mm","code_information":[{"code":"4301632","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301632","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Pca Microbore Tubing","code_information":[{"code":"4400122","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400122","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Prolene 6-0","code_information":[{"code":"4302019","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"99421 5-10min Virtual Visit","code_information":[{"code":"3331697","type":"CDM"},{"code":"521","type":"RC"},{"code":"99421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Hgb Poc Brady","code_information":[{"code":"112212006-QW","type":"CDM"},{"code":"305","type":"RC"},{"code":"85018","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Urinalysis test","code_information":[{"code":"3331686-QW","type":"CDM"},{"code":"307","type":"RC"},{"code":"81003","type":"CPT","modifier":"QW"}],"standard_charges":[{"setting":"outpatient","modifier_code":["QW"],"minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28}]}]},{"description":"Isovue-370 100 Ml Soln [Gmh]","code_information":[{"code":"3761008","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270131635","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Lidocaine 2% Pf Inj Sol 5 Ml Ventricular Arrhythmias [Gmh]","code_information":[{"code":"4503377","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":43,"gross_charge":45,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Sapphire Epidural Tubing (C)","code_information":[{"code":"3500315","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500315","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Adult Tall Crutches 5'10- 6'6 ( C )","code_information":[{"code":"4302472","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302472","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Dual Dispersive Electrode","code_information":[{"code":"4303064","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303064","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Gertie Spinal Ndl 3 1/2 22g X 90mm","code_information":[{"code":"3500102","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500102","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Jumpstart 2.5 (C)","code_information":[{"code":"4300555","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300555","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Novasure Co2 Cartridge","code_information":[{"code":"4309029","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309029","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Indigo Carmine 8 Mg/ml 5 Ml Inj Sol [Gmh]","code_information":[{"code":"4501301","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478050801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bupivacaine-epinephrine 0.5%-1:200,000 Pf Sol 10 Ml [Gmh]","code_information":[{"code":"4507235","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046217","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Ankle Stirrup Standard","code_information":[{"code":"4302430","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302430","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":42,"gross_charge":44,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":27}]}]},{"description":"Ankle Stirrup Small","code_information":[{"code":"4302428","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302428","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Dobutamine 12.5 Mg/ml Iv Sol [Gmh]","code_information":[{"code":"4508960","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409234401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Dextrose 5% In Water Iv Sol 250 Ml [Gmh]","code_information":[{"code":"4400251","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338001702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Monthly Data Collection And Reporting","code_information":[{"code":"33370011","type":"CDM"},{"code":"761","type":"RC"},{"code":"99454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Anes- Circuit Adult","code_information":[{"code":"3500220","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500220","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Co2 Detectors (C)","code_information":[{"code":"4300518","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300518","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Co2 Detector Pedi","code_information":[{"code":"4301091","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301091","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Esmark 4","code_information":[{"code":"4300634","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300634","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Foot Pedal-operated Cautery Pencil","code_information":[{"code":"4303075","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303075","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Gowns, Warming ( C )","code_information":[{"code":"4301990","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301990","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Gravity Infusion Kit","code_information":[{"code":"4400127","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400127","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Neoprene Knee Sleevemed","code_information":[{"code":"4308942","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308942","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Neoprene Knee Sleevesm","code_information":[{"code":"4308958","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308958","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Oxy- Nasal Cannula Hi-flo (C)","code_information":[{"code":"4302556","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302556","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Ram Cannula Preemie","code_information":[{"code":"4302513","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302513","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Ram Cannula Newborn","code_information":[{"code":"4302512","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302512","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Shoe, Surgical Med Womens","code_information":[{"code":"4302348","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302348","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Shoe, Surgical Sm Mens","code_information":[{"code":"4302458","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302458","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Silk 6-0 Q706h","code_information":[{"code":"4302266","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302266","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sport Ankle Splint Lg","code_information":[{"code":"4301653","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301653","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sport Trac Knee Strap Sm","code_information":[{"code":"4308945","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308945","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sport Trac Knee Strap Md","code_information":[{"code":"4308946","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308946","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sport Trac Knee Strap Lg","code_information":[{"code":"4308947","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308947","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sport Trac Knee Strap Xl","code_information":[{"code":"4308948","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308948","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Provox Life Night Hme","code_information":[{"code":"4301245","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301245","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Vancomycin 750 Mg Pow [Gmh]","code_information":[{"code":"4507174","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323020326","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Sufentanil 100 Mcg/2ml Iv Sol [Gmh]","code_information":[{"code":"4502616","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478005002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Meperidine 50 Mg/ml Inj Sol 1 Ml [Gmh]","code_information":[{"code":"4500796","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409117830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Adaptic Dressing 8x12 1/2","code_information":[{"code":"4300781","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300781","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Hydrocolloid Dressing 6x6 ( C )","code_information":[{"code":"4300770","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300770","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Neo/adult Spo2 Sensor (New) ( C )","code_information":[{"code":"4301132","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301132","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Oxisensor- Pedi ( C )","code_information":[{"code":"4301086","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301086","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Shoe, Surgical Lg Mens","code_information":[{"code":"4302460","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302460","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Ultra Sling Iii Strap","code_information":[{"code":"4302369","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302369","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Dexamethasone 10 Mg/ml Preservative-free Sol [Gmh]","code_information":[{"code":"4506033","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":41,"gross_charge":43,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Sacubitril-valsartan 49 Mg-51 Mg Tab [Gmh]","code_information":[{"code":"4507178","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078077720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":49,"type":"ME"}},{"description":"Clindamycin 300 Mg/50 Ml-nacl 0.9% Sol [Gmh]","code_information":[{"code":"4507208","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338954524","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bill Drug Screen Collection","code_information":[{"code":"3809999","type":"CDM"},{"code":"309","type":"RC"},{"code":"CP3809999","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Rbc Count","code_information":[{"code":"3800505","type":"CDM"},{"code":"305","type":"RC"},{"code":"85041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Adult Crutches 5'2- 5'10 ( C )","code_information":[{"code":"4302492","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302492","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Athletic Support Large","code_information":[{"code":"4300211","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300211","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Chest Tube 20fr","code_information":[{"code":"4300485","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300485","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Circuit For Ventilation Mask","code_information":[{"code":"4302545","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302545","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Flexbar Red","code_information":[{"code":"4303028","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Iv Splint Infant (C)","code_information":[{"code":"4400144","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400144","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Mepitel 3 X 4","code_information":[{"code":"4300754","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300754","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Promogran Prisma Silver ( C )","code_information":[{"code":"4300834","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300834","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sodium Chloride 0.9% Iv Sol 100 Ml [Gmh]","code_information":[{"code":"4400101","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338055318","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Cyanocobalamin 1000 Mcg/ml 1 Ml Soln [Gmh]","code_information":[{"code":"4500720","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517003125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ampicillin 1 G Inj [Gmh]","code_information":[{"code":"4500191","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781926195","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Anes- Spnl Ndl 25gx5 Penc (C)","code_information":[{"code":"3500291","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500291","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Angiocath 14ga X 1.88","code_information":[{"code":"4304104","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304104","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Electrosurgical Snare ( C )","code_information":[{"code":"4301192","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301192","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Sterile Synthetic 6in","code_information":[{"code":"4300345","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300345","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":40,"gross_charge":42,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":26}]}]},{"description":"Insufflation Ndl 120mm (C)","code_information":[{"code":"4300863","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300863","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Iv Splint Toddler (C)","code_information":[{"code":"4400120","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400120","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Mepilex 4x4 Ag Border","code_information":[{"code":"4300714","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300714","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Ob- Amniocentesis Tray","code_information":[{"code":"4301083","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301083","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Polyp Trap","code_information":[{"code":"4300888","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300888","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Safetouch Tissue Trap","code_information":[{"code":"4304039","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304039","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Y-type Tur Irrig Set","code_information":[{"code":"4301920","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301920","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Youth Crutches 4'6- 5'2","code_information":[{"code":"4302474","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302474","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Finger Splint,  Static","code_information":[{"code":"3335007","type":"CDM"},{"code":"270","type":"RC"},{"code":"Q4049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Povidone Iodine Ophth 5% Sol 30 Ml [Gmh]","code_information":[{"code":"4500415","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065041130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Valproic Acid 100 Mg/ml Sol 5ml [Gmh]","code_information":[{"code":"4503947","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Whitefoam Small Dressing (C)","code_information":[{"code":"4302079","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302079","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Tolterodine 2 Mg Ercap [Gmh]","code_information":[{"code":"4500825","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904659204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"6x9 Super Absorbent Dressing  ( C )","code_information":[{"code":"4300828","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300828","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Spring-wire Guide","code_information":[{"code":"4309004","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":39,"gross_charge":41,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Rocuronium 10 Mg/ml Iv Sol 5 Ml [Gmh]","code_information":[{"code":"4503187","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323042605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Methylprednisolone(solumedrol) 40 Mg Preservative-free Pow [Gmh]","code_information":[{"code":"4502012","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009003906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Butorphanol 1 Mg/ml Sol [Gmh]","code_information":[{"code":"4500595","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409162301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"I-gel Lma #4 (C)","code_information":[{"code":"3500312","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500312","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"I-gel Lma #3 (C)","code_information":[{"code":"3500313","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500313","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"I-gel Lma #5 (C)","code_information":[{"code":"3500311","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500311","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Bupivacaine-epinephrine 0.25%-1:200,000 Preservative-free Sol [Gmh]","code_information":[{"code":"4507134","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409174610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Pregabalin 100 Mg Cap [Gmh]","code_information":[{"code":"4505076","type":"CDM"},{"code":"250","type":"RC"},{"code":"00071101541","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Total Prot U24","code_information":[{"code":"3805059","type":"CDM"},{"code":"301","type":"RC"},{"code":"84156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"500ml Evac Container","code_information":[{"code":"4400124","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400124","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Aquacel Ag 4x5 ( C )","code_information":[{"code":"4300448","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300448","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Buretrol Sol Set","code_information":[{"code":"4400111","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400111","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Gi Biopsy Forcep ( C )","code_information":[{"code":"4308909","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308909","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Hydrogel 3oz","code_information":[{"code":"4300109","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300109","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"I-knife 15","code_information":[{"code":"4300395","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300395","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Iv Sol- 100cc Nacl W/co","code_information":[{"code":"4400104","type":"CDM"},{"code":"258","type":"RC"},{"code":"CP4400104","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Rib Belt Female Univ Lf","code_information":[{"code":"4302391","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302391","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Softshell Inverted (C)","code_information":[{"code":"4301401","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301401","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Epi-shugarcaine 0.025/0.75% Soln-opth","code_information":[{"code":"4507091","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999999888","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"I-gel Lma #1","code_information":[{"code":"3500316","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500316","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"I-gel Lma #2 (C)","code_information":[{"code":"3500318","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500318","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"I-gel Lma #2.5 (C)","code_information":[{"code":"3500319","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500319","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"I-gel Lma #1.5","code_information":[{"code":"3500317","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500317","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"24fr Silver 2 Way 5cc","code_information":[{"code":"4302134","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302134","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Bupivacaine 0.25% Pf Inj Sol 10 Ml [Gmh]","code_information":[{"code":"4504062","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046417","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Biatain Heel (C)","code_information":[{"code":"4301848","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":38,"gross_charge":40,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":25}]}]},{"description":"Lamotrigine 50 Mg Tab [Gmh]","code_information":[{"code":"4507177","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162095603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Magnesium Sulfate 10 Mg/ml-d5% Sol [Gmh]","code_information":[{"code":"4507180","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338170940","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ketorolac 30 Mg/ml 1 Ml Inj Sol [Gmh]","code_information":[{"code":"4501501","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409379501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ambu Bag, Infant (Disposable)","code_information":[{"code":"4300149","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300149","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Basic Pack ( C )","code_information":[{"code":"4301100","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301100","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Femoral Irrg/suct Brush","code_information":[{"code":"4304098","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304098","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Monocryl 3-0 Y936h (C)","code_information":[{"code":"4302341","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302341","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Monocryl 4-0 Y935h","code_information":[{"code":"4301777","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301777","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Prolene 6 #8697g ( C )","code_information":[{"code":"4302210","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302210","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Universal Ice Wrap","code_information":[{"code":"4300804","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300804","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Bupivacaine 0.5% Pf Inj Sol 30 Ml [Gmh]","code_information":[{"code":"4502042","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046637","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Magnesium Sulfate 4 G/100 Ml-sterile Water Sol [Gmh]","code_information":[{"code":"4507144","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121172009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Lidocaine 1% Inj Sol 20 Ml [Gmh]","code_information":[{"code":"4501580","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756064625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Diltiazem 5 Mg/ml Iv Sol [Gmh]","code_information":[{"code":"4500093","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641601410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Gentamicin 20 Mg/ 2ml  Inj Sol [Gmh]","code_information":[{"code":"4507052","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Additional 20 Minutes Rpm Services","code_information":[{"code":"33370013","type":"CDM"},{"code":"761","type":"RC"},{"code":"99458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Hydrocolloid Dressing 4x4 ( C )","code_information":[{"code":"4300769","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300769","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":37,"gross_charge":39,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":24}]}]},{"description":"Lidocaine 0.4%-d5w Inj Sol 500 Ml [Gmh]","code_information":[{"code":"4501018","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264959410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":24}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"Haloperidol 5 Mg/ml 1 Ml  Inj Sol [Gmh]","code_information":[{"code":"4502119","type":"CDM"},{"code":"250","type":"RC"},{"code":"10147091101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":24}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Gentamicin Ophthalmic 0.3% Soln [Gmh]","code_information":[{"code":"4501174","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758018805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":24}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Shoe, Surgical Sm Womens ( C )","code_information":[{"code":"4302347","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302347","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Shoe, Surgical Lg Womens","code_information":[{"code":"4302349","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302349","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Ball Electrode 5mm","code_information":[{"code":"4301634","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301634","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Cath Drain Bag Cover","code_information":[{"code":"4300392","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300392","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Cautery Nail Pen","code_information":[{"code":"4300463","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300463","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Cysto Pack (C)","code_information":[{"code":"4301905","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301905","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Nasal Rae Tube 4mm ( C )","code_information":[{"code":"3500255","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500255","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Propofol 10 Mg/ml Iv Emul 20 Ml [Gmh]","code_information":[{"code":"4502323","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":24}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Sodium Chloride 0.45% With Kcl 20 Meq/l Iv Sol 1000 Ml [Gmh]","code_information":[{"code":"4501164","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338070434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":24}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Myringotomy Blade ( C )","code_information":[{"code":"4300278","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300278","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":38,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Sacubitril-valsartan 24 Mg-26 Mg Tab [Gmh]","code_information":[{"code":"4507065","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078065920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Bupivacaine 0.5% Pf Sol 10 Ml [Gmh]","code_information":[{"code":"4507234","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046617","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Baby Stifneck Collar","code_information":[{"code":"4302352","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302352","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Collection Canister","code_information":[{"code":"4305511","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305511","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Latch Assist","code_information":[{"code":"4301050","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301050","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Monocryl 4-0 Y426h","code_information":[{"code":"4300284","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300284","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Neoprene Knee Sleeve Lrg","code_information":[{"code":"4308943","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308943","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Neoprene Knee Sleeve Xl","code_information":[{"code":"4308944","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308944","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Retrobulbar Ndl","code_information":[{"code":"4300360","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300360","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Shoulder Imb, Mens Med","code_information":[{"code":"4302443","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302443","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Splint, Alum, R Child","code_information":[{"code":"4302413","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302413","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Splint, Alum, L Child","code_information":[{"code":"4302416","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302416","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Splint, Alum, R Youth","code_information":[{"code":"4302414","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302414","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Splint, Alum, L Youth","code_information":[{"code":"4302412","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302412","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Universal Ice Wrap Long","code_information":[{"code":"4300805","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300805","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Vicryl 5-0 Rapide Vr844","code_information":[{"code":"4301617","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301617","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"94640 Nebulizer Administration Charge","code_information":[{"code":"3331684","type":"CDM"},{"code":"521","type":"RC"},{"code":"94640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Monocryl 4-0 Mcp426h","code_information":[{"code":"4302281","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302281","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Lvp Solution With Potassium Dextrose 5% With 0.9% Nacl And Kcl 20 Meq/l Sol [Gmh]","code_information":[{"code":"4507232","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264765200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":5,"type":"UN"}},{"description":"16fr 2-way W/5ml Silver ( C )","code_information":[{"code":"4302102","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302102","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"18fr 2-way W/5 Ml Silver","code_information":[{"code":"4302103","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302103","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23}]}]},{"description":"Digoxin 250 Mcg/ml (0.25 Mg/ml) Sol [Gmh]","code_information":[{"code":"4501544","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641141035","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":36,"gross_charge":37,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Apixaban 2.5 Mg Tab Ud [Gmh]","code_information":[{"code":"4505073","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003089331","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Apixaban 5 Mg Tab Ud [Gmh]","code_information":[{"code":"4507190","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003089431","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bupivacaine 0.75% Pf Inj Sol 10 Ml [Gmh]","code_information":[{"code":"4500478","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323047217","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Magnesium Sulfate 50% Sol Inj 10 Ml [Gmh]","code_information":[{"code":"4505058","type":"CDM"},{"code":"250","type":"RC"},{"code":"51754100004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Bill Venipuncture","code_information":[{"code":"3800655","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Collection: Cord Blood","code_information":[{"code":"3806091","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Collection: Iv Start","code_information":[{"code":"3806088","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Cath 22fr 2-way W/30cc","code_information":[{"code":"4302025","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302025","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Insulated Blade Electrode 2.75 In","code_information":[{"code":"4301000","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Medihoney .5 Oz ( C )","code_information":[{"code":"4300115","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300115","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Shoulder Imb, Mens Sm","code_information":[{"code":"4302442","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302442","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Phenylephrine Ophthalmic 10% Sol [Gmh]","code_information":[{"code":"4501049","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478020510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Disp 4 Pc Aws Valve Set (C)","code_information":[{"code":"4300162","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300162","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Prolene 4-0 8682g","code_information":[{"code":"4302244","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302244","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":35,"gross_charge":36,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":22}]}]},{"description":"Safetouch Btl And Lid 3/8","code_information":[{"code":"4306007","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Proximate Skin Stapler (C)","code_information":[{"code":"4301661","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301661","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Cast- Stockinette 2 Synt","code_information":[{"code":"4301692","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301692","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Shoulder Imb, Mens Lg","code_information":[{"code":"4302444","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302444","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Shoulder Imb, Womens Sm","code_information":[{"code":"4302447","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302447","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Vicryl 4-0 Vcp422h","code_information":[{"code":"4302288","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302288","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Allergy Injection Multiple, Professional Service Charge","code_information":[{"code":"3332256","type":"CDM"},{"code":"517","type":"RC"},{"code":"95117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"00409-3795-01ketorolac 30.  Soln [Gmh]","code_information":[{"code":"CP17805909290861920","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"63323-0162-01ketorolac 30 Mg/ml 1 Ml Inj Sol [Gmh]","code_information":[{"code":"CP17805909291145914","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Phenytoin 50 Mg/ml Sol [Gmh]","code_information":[{"code":"4505064","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192061430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Hydromorphone 2 Mg/ml Sol [Gmh]","code_information":[{"code":"4506016","type":"CDM"},{"code":"250","type":"RC"},{"code":"76045001011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Pregabalin 25 Mg Cap Ud [Gmh]","code_information":[{"code":"4501047","type":"CDM"},{"code":"250","type":"RC"},{"code":"00071101268","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sodium Hypochlorite Topical 0.5% Sol [Gmh]","code_information":[{"code":"4505043","type":"CDM"},{"code":"250","type":"RC"},{"code":"00436094616","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Potassium Chloride 10 Meq/100 Ml Iv Sol 100 Ml [Gmh]","code_information":[{"code":"4501103","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990707426","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Elilik Evacuator","code_information":[{"code":"4301915","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301915","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Hydrocolloid Dressing 2x2 ( C )","code_information":[{"code":"4300768","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300768","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Saline Sterile 3000 Bag ( C )","code_information":[{"code":"4300816","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300816","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":34,"gross_charge":35,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Dopamine 40 Mg/ml Iv Sol [Gmh]","code_information":[{"code":"4508962","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409582001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Phenylephrine 10 Mg/ml Sol [Gmh]","code_information":[{"code":"4503504","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641614225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nexiva 20g Diffusics (C)","code_information":[{"code":"4400176","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400176","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Nexiva 22g Diffusics (C)","code_information":[{"code":"4400177","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400177","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Nexiva 24g Diffusics (C)","code_information":[{"code":"4400178","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400178","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Dextrose 5% With 0.45% Nacl And Kcl 20 Meq/l Iv Sol 1000 Ml [Gmh]","code_information":[{"code":"4500152","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338067104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Celecoxib 100 Mg Cap [Gmh]","code_information":[{"code":"4500592","type":"CDM"},{"code":"250","type":"RC"},{"code":"00025152034","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cgm Interpretation","code_information":[{"code":"33370005","type":"CDM"},{"code":"761","type":"RC"},{"code":"95251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Adult Spo2 Sensor ( C )","code_information":[{"code":"4301126","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301126","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Comf Wrist Supp R Xsm","code_information":[{"code":"4302608","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302608","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Iv Splint Lg Child (C)","code_information":[{"code":"4400143","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400143","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Monocryl 5-0 Y493g","code_information":[{"code":"4302238","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302238","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Pedi Spo2 Sensor (C)","code_information":[{"code":"4301130","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301130","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Peep Valve","code_information":[{"code":"4302529","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302529","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Plain 5-0 1915g","code_information":[{"code":"4302241","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302241","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Promogran Prisma Dressing 4 1/3 ( C )","code_information":[{"code":"4300740","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300740","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Urostomy Kit","code_information":[{"code":"4300506","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300506","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Gentamicin 80 Mg / 2 Ml Inj Sol [Gmh]","code_information":[{"code":"4501264","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Acetaminophen-hydrocodone 217 Mg-5 Mg/10 Ml Liq Ud [Gmh]","code_information":[{"code":"4507221","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121154440","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":217,"type":"ME"}},{"description":"Amiodarone 50 Mg/ml Iv Sol [Gmh]","code_information":[{"code":"4503911","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Metronidazole 500 Mg/100 Ml Iv Sol [Gmh]","code_information":[{"code":"4501747","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000000124","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Olanzapine 2.5 Mg Tab [Gmh]","code_information":[{"code":"4503427","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505311000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ted's, Thigh High 2x (C)","code_information":[{"code":"4302483","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302483","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21}]}]},{"description":"Epinephrine-lidocaine 1:100,000-1% Soln [Gmh]","code_information":[{"code":"4503102","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Promethazine 50 Mg/ml Inj Sol 1 Ml [Gmh]","code_information":[{"code":"4502297","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822555006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":33,"gross_charge":34,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Bupivacaine 0.75% Intrathecal Sol 2 Ml [Gmh]","code_information":[{"code":"4501703","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409176102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Sterile Water Inj Sol 100 Ml [Gmh]","code_information":[{"code":"4501077","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409488799","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Sterile Water Inj Sol 10 Ml [Gmh]","code_information":[{"code":"4504020","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323018510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Block Needle","code_information":[{"code":"4309001","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Bone Wax","code_information":[{"code":"4300258","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300258","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Cautery W/ Coated Blade","code_information":[{"code":"4300421","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300421","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Chromic 3-0 636h","code_information":[{"code":"4302165","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302165","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Comf Wrist Supp L Xsm","code_information":[{"code":"4302603","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302603","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Comf Wrist Supp R Xl","code_information":[{"code":"4302612","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302612","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Disp 3 Pc Aws Valve Set (Reorder Awsvalve4-kit #4300165) ( C )","code_information":[{"code":"4300164","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300164","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Drain, J P","code_information":[{"code":"4300870","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300870","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Lighted 18mm Anoscope","code_information":[{"code":"4300153","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300153","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Lugols 8ml","code_information":[{"code":"4300589","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300589","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Maxon 1 6287-71","code_information":[{"code":"4302495","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302495","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Polyp Trap ( Olympus ) ( C )","code_information":[{"code":"4300884","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300884","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Ted's, Thigh High 3x","code_information":[{"code":"4302484","type":"CDM"},{"code":"CP4302484","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Vicryl 4-0 Rapide Vr845","code_information":[{"code":"4301619","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301619","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Clotrimazole Top 1% Crm [Gmh]","code_information":[{"code":"4503258","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672200202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocortisone Topical 2.5% Cream [Gmh]","code_information":[{"code":"4501286","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168008031","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Polyethylene Glycol 3350 Oral Pwdr For Recon 238 Gm [Gmh]","code_information":[{"code":"4506067","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536105224","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":238,"type":"GR"}},{"description":"Oxytocin 10,000 Munits/ml Inj Sol 1 Ml [Gmh]","code_information":[{"code":"4502200","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023011625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Prolene 4-0 Ps2 8682h (C)","code_information":[{"code":"4302146","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302146","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Lidocaine 2% Preservative-free Sol 5 Ml Surgery Use Only[gmh]","code_information":[{"code":"4504107","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Lorazepam 2 Mg/ml Inj Sol 1 Ml [Gmh]","code_information":[{"code":"4503742","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409198530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Bumetanide 2.5  Soln [Gmh]","code_information":[{"code":"4503728","type":"CDM"},{"code":"250","type":"RC"},{"code":"65219057210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Clindamycin 150 Mg/ml 4 Ml Iv Sol [Gmh]","code_information":[{"code":"4503688","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021011504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Capno Cannula Adult ( C )","code_information":[{"code":"3500254","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500254","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Epidural Ndl 20ga X 3 1/2","code_information":[{"code":"4304175","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304175","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Ndl Epidural Tuohy 17 X 3 1/2","code_information":[{"code":"3500323","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500323","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Y-type Blood Set","code_information":[{"code":"4400157","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400157","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":32,"gross_charge":33,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Bumetanide 0.25 Mg/ml Inj Sol 4 Ml [Gmh]","code_information":[{"code":"4500067","type":"CDM"},{"code":"250","type":"RC"},{"code":"65219057004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Endo Bedside Kit (C)","code_information":[{"code":"4300161","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300161","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Tobramycin 40 Mg/ml Inj Sol [Gmh]","code_information":[{"code":"4504500","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lidocaine 1% Pf Inj Sol 5 Ml Surgery Use Only [Gmh]","code_information":[{"code":"4501012","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049236","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Metoclopramide 5 Mg/ml Inj Sol 2 Ml [Gmh]","code_information":[{"code":"4501756","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703450204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lidocaine 2% Inj Sol 20 Ml [Gmh]","code_information":[{"code":"4503952","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048627","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Occupational Health Audiogram","code_information":[{"code":"4230006","type":"CDM"},{"code":"521","type":"RC"},{"code":"CP4230006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"0 Pds Pdp990g","code_information":[{"code":"4301754","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301754","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"27ga Bent Tip Cann","code_information":[{"code":"4300433","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300433","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Cath 16fr 30cc Lubri-sil","code_information":[{"code":"4302026","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Needle Epidural 17ga X 4 1/2","code_information":[{"code":"4304183","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304183","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Scope Warmer Disp ( C )","code_information":[{"code":"4301274","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301274","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Shoulder Imb, Womens Lg","code_information":[{"code":"4302449","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302449","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Spear-juvenile Flat Bladeangled Nohandle","code_information":[{"code":"4305520","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305520","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Splint, Alum, R Adult","code_information":[{"code":"4302415","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302415","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Splint, Alum, L Adult","code_information":[{"code":"4302418","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302418","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Valve Single Use Sterile(do Not Order)","code_information":[{"code":"4301197","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301197","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Vicryl 4-0 J504g","code_information":[{"code":"4302275","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302275","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Fluid Trap (C)","code_information":[{"code":"4306006","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Diabetes Education/training For Pt. Self-management, Face To Face With The Pt. Individual","code_information":[{"code":"3331959","type":"CDM"},{"code":"942","type":"RC"},{"code":"98960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Prolene 4 #8699g (C)","code_information":[{"code":"4302205","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302205","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":31,"gross_charge":32,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":20}]}]},{"description":"Neoheart Ecg Pad","code_information":[{"code":"4304517","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304517","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Rosuvastatin 10. Mg Tab [Gmh]","code_information":[{"code":"4503858","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310075139","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Braun Spike Port Adaptor ( C )","code_information":[{"code":"4401123","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4401123","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Braun Vial Adaptor ( C )","code_information":[{"code":"4401122","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4401122","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Capno Cannula Pedi (C)","code_information":[{"code":"3500253","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500253","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Collection Set Tubing","code_information":[{"code":"4305512","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305512","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Comf Wrist Supp L Lg","code_information":[{"code":"4302606","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302606","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Comf Wrist Supp L X-lg","code_information":[{"code":"4302607","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302607","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Fall Risk Kit","code_information":[{"code":"4304020","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Full Leg Ted Xlg Long W/belt","code_information":[{"code":"4301633","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301633","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Monocryl 4-0 Y494g ( C )","code_information":[{"code":"4302239","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302239","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Prolene 4 #8604g","code_information":[{"code":"4302207","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302207","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Sampling Line Neonate","code_information":[{"code":"4304031","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304031","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Tensoplast 4","code_information":[{"code":"4300327","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300327","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Opti-gard Eye Guard Foam (C)","code_information":[{"code":"4309200","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309200","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Lidocaine Topical 5% Patch [Gmh]","code_information":[{"code":"4505065","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162079108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Heparin 5000 Units/ml 1 Ml Inj Sol [Gmh]","code_information":[{"code":"4501234","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457037499","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Hydophilic Foam Dressing 4x4 ( C )","code_information":[{"code":"4300548","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300548","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Mepilex 4x4 (C)","code_information":[{"code":"4300704","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300704","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Iv Port Dressing Chg","code_information":[{"code":"4300274","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300274","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Pall Filter","code_information":[{"code":"4308980","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP4308980","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":30,"gross_charge":31,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":19}]}]},{"description":"Midazolam 1 Mg/ml Preservative-free Inj Sol 2 Ml  [Gmh]","code_information":[{"code":"4501772","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069081610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ethibond 3-0 X872h (C)","code_information":[{"code":"4301250","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301250","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"90472 Clinic Immun Admin: Each Additional Vaccine","code_information":[{"code":"3334202","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Sdoh Assessment Charge","code_information":[{"code":"3331962","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"90471 Flu (Influenza) Immunization Admin Charge","code_information":[{"code":"3331056","type":"CDM"},{"code":"521","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"97530 Job Sight Analysis 15 Min Charge","code_information":[{"code":"4230192-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97530","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Oxygen E Cylinder","code_information":[{"code":"3900019","type":"CDM"},{"code":"410","type":"RC"},{"code":"CP3900019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Anes- Lma Madgic (C)","code_information":[{"code":"3500295","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500295","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Bss 500ml ( Sightpath )","code_information":[{"code":"4300918","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300918","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Esophageal Temp Stethoscope","code_information":[{"code":"3500350","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500350","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Monocryl 5-0 Y495g","code_information":[{"code":"4301233","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301233","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Nitro Set With Spike","code_information":[{"code":"4401118","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4401118","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Peak Flow Meter","code_information":[{"code":"4302601","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302601","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Plain Gut 4-0 1644g","code_information":[{"code":"4302486","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302486","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Pocket Resucitator- Pedi","code_information":[{"code":"4301191","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301191","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Pressure Infusion Bag","code_information":[{"code":"4301206","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301206","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Sampling Line (C)","code_information":[{"code":"4304057","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304057","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Shoe, Surgical Med Mens ( C )","code_information":[{"code":"4302459","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302459","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Ua Drainage Bag W/meter","code_information":[{"code":"4300393","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300393","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"90480 Covid 19 Vaccine Administration","code_information":[{"code":"3332353","type":"CDM"},{"code":"771","type":"RC"},{"code":"90480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Cardiovas Stress Test Using Maximal/submaximal Treadmill Or Bike Exercise, Cont.report Only","code_information":[{"code":"3332253","type":"CDM"},{"code":"521","type":"RC"},{"code":"93018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"90460 Flu (Influenza) Immunziation Admin Charge","code_information":[{"code":"3331057","type":"CDM"},{"code":"771","type":"RC"},{"code":"90460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"90460 Immun Admin, One Vaccine Peds","code_information":[{"code":"3331060","type":"CDM"},{"code":"771","type":"RC"},{"code":"90460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"96380 Rsv Vaccine Admin W/counseling Charge","code_information":[{"code":"3331059","type":"CDM"},{"code":"771","type":"RC"},{"code":"96380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"96381 Rsv Vaccine Admin Charge","code_information":[{"code":"3331052","type":"CDM"},{"code":"771","type":"RC"},{"code":"96381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Admin Influenza Virus Vaccine Medicare Poc","code_information":[{"code":"3334133","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Admin Hepatitis B Vaccine Charge Gbmh","code_information":[{"code":"3332399","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Admin Of Pneumoccocal Immunization","code_information":[{"code":"333G009","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Imm Adm >8 1st Orl/n Nsg Charge","code_information":[{"code":"3331062","type":"CDM"},{"code":"510","type":"RC"},{"code":"90473","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Diphenhydramine 50 Mg/ml 1 Ml Inj Sol [Gmh]","code_information":[{"code":"4503382","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Biatain Silicone 4x4 (C)","code_information":[{"code":"4301838","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Lidocaine-prilocaine Topical 2.5% 5 G [Gmh]","code_information":[{"code":"4501108","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168035755","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Benzoin Topical Compound 60 Ml [Gmh]","code_information":[{"code":"4505016","type":"CDM"},{"code":"250","type":"RC"},{"code":"00395024392","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":60,"type":"ML"}},{"description":"Hemophilus Influenza B Vaccine (Hib), Hboc Conjugate (4 Dose), Im Poc","code_information":[{"code":"3334206","type":"CDM"},{"code":"636","type":"RC"},{"code":"90648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":29,"gross_charge":30,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Dexamethasone 4 Mg/ml 1 Ml Inj Sol [Gmh]","code_information":[{"code":"4500788","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Levalbuterol 1.25 Mg/3 Ml Inh Sol [Gmh]","code_information":[{"code":"4501068","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402051324","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Oxymask W/ Co2 Pedi ( C )","code_information":[{"code":"4302564","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302564","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Monocryl 3-0 Y427h","code_information":[{"code":"4302318","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302318","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"97802-nutrition Counseling, Initial (Ppp Service)","code_information":[{"code":"33370007","type":"CDM"},{"code":"761","type":"RC"},{"code":"97802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Triamcinolone 10 Mg/ml Sus","code_information":[{"code":"4507155","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003049420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Brace, Clavicle, Med","code_information":[{"code":"4302487","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302487","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Burn Dressing 4 X 10","code_information":[{"code":"4300107","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300107","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Chloraprep 26ml Orange ( C )","code_information":[{"code":"4305507","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305507","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Colostomy Kit 1 3/4","code_information":[{"code":"4300509","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300509","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Disposable Linen Kit","code_information":[{"code":"4300182","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300182","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Filter Assembly","code_information":[{"code":"4306008","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306008","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Infant Ambu Mask ( C )","code_information":[{"code":"4300326","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300326","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Monocryl 3-0 Y497g","code_information":[{"code":"4301715","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301715","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Newborn Ambu Tubing","code_information":[{"code":"4300321","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300321","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Pedi Circuit","code_information":[{"code":"3500228","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500228","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Prolene 3-0 8687h","code_information":[{"code":"4302258","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302258","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Pulley System","code_information":[{"code":"4301181","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301181","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Safergel Single Sterile (C)","code_information":[{"code":"4304327","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304327","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Sterile Synthetic 4in","code_information":[{"code":"4300342","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300342","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Sween Cream Lotion (C)","code_information":[{"code":"4300967","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300967","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Morphine 4 Mg/ml Pf  Sol 1 Ml [Gmh]","code_information":[{"code":"4504054","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ethilon 6 #1665g (C)","code_information":[{"code":"4302226","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302226","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Allevyn 4x4","code_information":[{"code":"4300697","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300697","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Colostomy Stoma Adhesive Paste","code_information":[{"code":"4300502","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300502","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Tucks","code_information":[{"code":"4301036","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":28,"gross_charge":29,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":18}]}]},{"description":"Sterile Water Inj 50 Mlsol [Gmh]","code_information":[{"code":"4507045","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409488750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Tobramycin Ophthalmic 0.3% Sol [Gmh]","code_information":[{"code":"4502823","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Collection: Fingerstick","code_information":[{"code":"3806089","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Collection: Capillary","code_information":[{"code":"3806191","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Collection: Heel Stick","code_information":[{"code":"3806090","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Ambu Bag Pediatric","code_information":[{"code":"4300151","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300151","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Anes- Et Tube Introducer","code_information":[{"code":"3500281","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500281","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Brace, Clavicle, Children","code_information":[{"code":"4302420","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302420","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Brace, Clavicle Sm","code_information":[{"code":"4302421","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302421","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Brace, Clavicle, Lrg","code_information":[{"code":"4302422","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302422","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Brace, Clavicle, Xlrg","code_information":[{"code":"4302423","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302423","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Ethilon 4-0 1854g","code_information":[{"code":"4302221","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302221","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Ethilon 5 #G695g","code_information":[{"code":"4302224","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302224","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Jurgan Pin Ball .035","code_information":[{"code":"4306712","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306712","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Jurgan Pin Ball .054","code_information":[{"code":"4306714","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306714","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Powerloc 20ga X 1","code_information":[{"code":"4400158","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400158","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Powerloc 20ga X .75 ( C )","code_information":[{"code":"4400160","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400160","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Prolene 3-0 8842h","code_information":[{"code":"4302204","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302204","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Prolene 5 #8698g","code_information":[{"code":"4302208","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302208","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Tegaderm Chg 3 1/2 X 4 1/2 (C)","code_information":[{"code":"4300214","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300214","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Transducer Cover","code_information":[{"code":"4304024","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Vicryl 4-0 J464g","code_information":[{"code":"4301774","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301774","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Vicryl 4-0 Vcp494h ( C )","code_information":[{"code":"4302237","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302237","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Fentanyl 100mcg/2ml Inj Sol [Gmh]","code_information":[{"code":"4501095","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641602725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Marathon Xl (C)","code_information":[{"code":"4300836","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300836","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Nexiva 24 Ga ( C )","code_information":[{"code":"4400121","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400121","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Opticell Dressing 6x6","code_information":[{"code":"4300785","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300785","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Promethazine 25 Mg/ml Inj Sol 1 Ml [Gmh]","code_information":[{"code":"4502295","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822552503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":27,"gross_charge":28,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sodium Chloride Bacteriostatic 0.9% 30 Ml Sol [Gmh]","code_information":[{"code":"4500411","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323092430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Ondansetron 2 Mg/ml Inj Sol 2 Ml [Gmh]","code_information":[{"code":"4503868","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Under Body Warming Blanket (C)","code_information":[{"code":"4301998","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301998","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Aerochamber Holding Chamber ( C )","code_information":[{"code":"4302525","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302525","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Ethilon 6-0 697g","code_information":[{"code":"4302227","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302227","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Jurgan Pin Ball .028","code_information":[{"code":"4306711","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306711","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Jurgan Pin Ball .045","code_information":[{"code":"4306713","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306713","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Powerloc 19ga X 1","code_information":[{"code":"4400153","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400153","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Powerloc 22ga X .75 ( C )","code_information":[{"code":"4400155","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400155","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Sputum Cup ( C )","code_information":[{"code":"4301660","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301660","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Vicryl 4-0 Ps2 Vcp426h (C)","code_information":[{"code":"4302142","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302142","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Num Sterile Vapocoolant [Gmh]","code_information":[{"code":"4507192","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999111199","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Knee/heel Protector ( C )","code_information":[{"code":"4300755","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300755","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Regional Anesthesia Tray","code_information":[{"code":"3500212","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500212","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Urgotul 4x5","code_information":[{"code":"4301831","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Memantine 10 Mg Tab [Gmh]","code_information":[{"code":"4503840","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456321063","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxy-oxymask W/co2 ( C )","code_information":[{"code":"4302551","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302551","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":26,"gross_charge":27,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":17}]}]},{"description":"Ambu Bag, Adult (C)","code_information":[{"code":"4300150","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300150","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"9.5mm Inner Trach","code_information":[{"code":"4302509","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302509","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Aerogen Adapter","code_information":[{"code":"4302527","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302527","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Biopatch 1in ( C )","code_information":[{"code":"4306005","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Bubble Humidifier 370ml (C)","code_information":[{"code":"4301731","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301731","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Cautery Exten Blade 6.5","code_information":[{"code":"4300468","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300468","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Cooper Smoke Evacuator Reducer","code_information":[{"code":"4303066","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303066","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Ethilon 4-0 699g","code_information":[{"code":"4309005","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Flat Drain","code_information":[{"code":"4300578","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300578","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Infant/pedi Lumbar (C)","code_information":[{"code":"4301629","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301629","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Laryngeal Mask # 2 Disp (C)","code_information":[{"code":"3500230","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500230","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Mad Nasal Device (C)","code_information":[{"code":"4301627","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301627","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Needle Whitacre Spinal 25ga X 5","code_information":[{"code":"4304187","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304187","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Neuro Sponge 1/2 X 6","code_information":[{"code":"4300690","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300690","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Ob- Meconium Aspirator","code_information":[{"code":"4301082","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301082","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Prolene 4-0 8521h","code_information":[{"code":"4302212","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302212","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Shoe, Surgical Xlg Men ( C )","code_information":[{"code":"4302461","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302461","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Whitacre Spinal Ndl 22 X 3 1/2","code_information":[{"code":"4304174","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304174","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Drawtex 4x4 Dressing","code_information":[{"code":"4301829","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301829","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Donepezil 10 Mg Tab [Gmh]","code_information":[{"code":"4500255","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756044583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Metoprolol 1 Mg/ml  5 Ml Inj Sol [Gmh]","code_information":[{"code":"4501771","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000003310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Combiguard Wound Irrigation","code_information":[{"code":"4301254","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301254","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Cervical Collar, Pedi","code_information":[{"code":"4302376","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302376","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Free Needle Mayo ( C )","code_information":[{"code":"4301194","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301194","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Inhalation H20 Btl 1000ml","code_information":[{"code":"4300811","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300811","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"Topical Pain Rub 3oz","code_information":[{"code":"4300825","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300825","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}]},{"description":"86580 Tubersol Charge","code_information":[{"code":"3334212","type":"CDM"},{"code":"636","type":"RC"},{"code":"86580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":25,"gross_charge":26,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Biatain Multishape (C)","code_information":[{"code":"4301847","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Multihance 10 Ml Soln [Gmh]","code_information":[{"code":"3771003","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270516413","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":10,"type":"ML"}},{"description":"Phenytoin 50 Mg/ml 2ml Inj Sol [Gmh]","code_information":[{"code":"4502193","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641049325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":50,"type":"ME"}},{"description":"Gentian Violet Topical 1% Sol [Gmh]","code_information":[{"code":"4501083","type":"CDM"},{"code":"250","type":"RC"},{"code":"00395100392","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":"EA"}},{"description":"Adult Et Tube Holder","code_information":[{"code":"3500320","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500320","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Pedi Et Tube Holder","code_information":[{"code":"3500321","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500321","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Ot Hot, Cold Pack Rehab Units","code_information":[{"code":"4200115-GO","type":"CDM"},{"code":"431","type":"RC"},{"code":"97010","type":"CPT","modifier":"GO"}],"standard_charges":[{"setting":"outpatient","modifier_code":["GO"],"minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"1 Pds Ii Z881g","code_information":[{"code":"4301756","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301756","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Cast- Stockinette 2 Cotton","code_information":[{"code":"4301695","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301695","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Cautery Pad, Pediatric","code_information":[{"code":"4300454","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300454","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Coated Ndl Electrode","code_information":[{"code":"4300467","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300467","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Ethilon 4 #1667g","code_information":[{"code":"4302218","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302218","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Ethilon 5-0 1668g","code_information":[{"code":"4302223","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302223","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Headbed Immobilizeruniv","code_information":[{"code":"4302351","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302351","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Insulated Ndl Electrode","code_information":[{"code":"4300451","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300451","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Polysorb 1 Cl824l","code_information":[{"code":"4301759","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301759","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Prolene 6-0 8695g","code_information":[{"code":"4302211","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302211","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Statlock Picc Fixed","code_information":[{"code":"4301725","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301725","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Vaginal Packing","code_information":[{"code":"4301150","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301150","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Water Sterile 1000 Bag (C)","code_information":[{"code":"4300826","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300826","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Allergy Injection Professional Service Charge","code_information":[{"code":"3332255","type":"CDM"},{"code":"510","type":"RC"},{"code":"95115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Brimonidine Ophthalmic 0.2% Sol","code_information":[{"code":"4507230","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":2,"type":"EA"}},{"description":"Midazolam 5 Mg/ml Preservative-free Inj Sol 2 Ml [Gmh]","code_information":[{"code":"4501774","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409230802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":5,"type":"ME"}},{"description":"Cont-flo W/spike Adaptor ( C )","code_information":[{"code":"4401012","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4401012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Erythromycin Ophth 0.5% 1 Gm Oint [Gmh]","code_information":[{"code":"4501058","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208091019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":"GR"}},{"description":"Ranolazine 500. Mg Tab-er [Gmh]","code_information":[{"code":"4500171","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958100301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":500,"type":"ME"}},{"description":"Budesonide 0.5 Mg/2 Ml Inh Susp [Gmh]","code_information":[{"code":"4503420","type":"CDM"},{"code":"250","type":"RC"},{"code":"00186198904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":5,"type":"ME"}},{"description":"Optilock Dressing 8x12","code_information":[{"code":"4300759","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300759","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Spinal Ndl 22ga X 5 Quincke","code_information":[{"code":"4304173","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304173","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Lamivudine 150. Mg Tab [Gmh]","code_information":[{"code":"4504007","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084057821","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":24,"gross_charge":25,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":150,"type":"ME"}},{"description":"Cont. Flow Set ( C )","code_information":[{"code":"4400116","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400116","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Polysorb 0 Cl-924 ( C )","code_information":[{"code":"4301762","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301762","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Silver Alginate 2x2 ( C )","code_information":[{"code":"4300766","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300766","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"97803-nutrition Counseling, Re-assessment (Ppp Service)","code_information":[{"code":"33370008","type":"CDM"},{"code":"761","type":"RC"},{"code":"97803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Mini Brush","code_information":[{"code":"4301203","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301203","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Pocket Resucitator","code_information":[{"code":"4301186","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301186","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Vacurette Curved 14mm","code_information":[{"code":"4306013","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306013","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Vacurette Curved 16mm","code_information":[{"code":"4306014","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306014","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Vicryl 4-0 J494g","code_information":[{"code":"4302286","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302286","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Wrist W/thumb Abd. Univ.","code_information":[{"code":"4301993","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301993","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Bacteriostatic Water 30ml  Vial [Gmh]","code_information":[{"code":"4500410","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409397703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Amiodarone 200 Mg Tab [Gmh]","code_information":[{"code":"4503906","type":"CDM"},{"code":"250","type":"RC"},{"code":"00245014701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Potassium Chloride 2 Meq/ml (20meq/10ml) Sol [Gmh]","code_information":[{"code":"4507079","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323096510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Duloxetine 30 Mg Cap [Gmh]","code_information":[{"code":"4504021","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241009803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Neuro Sponge 1/2in X 1/2in","code_information":[{"code":"4300691","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300691","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Nexiva 18ga ( C )","code_information":[{"code":"4400117","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400117","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":23,"gross_charge":24,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":15}]}]},{"description":"Natural Tears Opht Ointment (Lacri-lube, Akwa Tears Oint.) [Gmh]","code_information":[{"code":"4501520","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023031204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine Top 2% Gel W/appl 5 Ml [Gmh]","code_information":[{"code":"4501383","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Ethibond 3-0 X522h","code_information":[{"code":"4302327","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302327","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Azithromycin 250 Mg Tab [Gmh]","code_information":[{"code":"4503152","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862064163","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Sodium Chloride 0.9% Inj Sol 10 Ml Vial [Gmh]","code_information":[{"code":"4502549","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409488810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Cervical Collar, Foam, Xs","code_information":[{"code":"4302373","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302373","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Cervical Collar, Foam, Sm","code_information":[{"code":"4302374","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302374","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Mcgowan 1859-4dc","code_information":[{"code":"4302063","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302063","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Plaster Casting 3","code_information":[{"code":"4300338","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300338","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Preemie Ambu Mask","code_information":[{"code":"4300325","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300325","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Shoulder Imb, Womens Med","code_information":[{"code":"4302448","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302448","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Shoulder Imb, Womens Xlg","code_information":[{"code":"4302450","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302450","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Nexiva 20ga ( C )","code_information":[{"code":"4400119","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400119","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Nexiva 22ga ( C )","code_information":[{"code":"4400118","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400118","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Amoxicillin-clavulanate 875 Mg-125 Mg Tab [Gmh]","code_information":[{"code":"4503860","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687080301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Aeroeclipse Ban (C)","code_information":[{"code":"4302523","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302523","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Aeroeclipse Mouthpiece","code_information":[{"code":"4302522","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302522","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Anchor Needle 7/16 Circ Tpr","code_information":[{"code":"4302214","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302214","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Bronchoscopy Biopsy Valve Maj-210","code_information":[{"code":"4300571","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300571","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Cervical Collar Adult Univ ( C )","code_information":[{"code":"4308913","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308913","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Coated Blade Electrode 125mm","code_information":[{"code":"4301110","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301110","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Ethilon 5-0 1855g","code_information":[{"code":"4302243","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302243","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Monocryl 3-0 Y523h","code_information":[{"code":"4302197","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302197","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Monopolar Cord (C)","code_information":[{"code":"4300752","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300752","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Nexiva 24ga X .75 (C)","code_information":[{"code":"4400147","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400147","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Ob- Nipple Shield Med 24mm","code_information":[{"code":"4301026","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301026","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Ob-nipple Shield Xs","code_information":[{"code":"4301023","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Ofp Byrne Irrigation","code_information":[{"code":"4301201","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301201","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Pedi Percussor Cup (C)","code_information":[{"code":"4302516","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302516","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Post-op Kit ( Sightpath )","code_information":[{"code":"4300943","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300943","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Single Use Splint 4 X 15","code_information":[{"code":"4300541","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300541","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Skin Stapler","code_information":[{"code":"4301280","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301280","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Snap Ring","code_information":[{"code":"4300735","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300735","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Sterile H20 Inhalation 1000ml","code_information":[{"code":"4401009","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4401009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Sterile Synthetic 2in (C)","code_information":[{"code":"4300343","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300343","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Sterile Synthetic 3in","code_information":[{"code":"4300344","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300344","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Tonsil Anchor Needle","code_information":[{"code":"4302217","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302217","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Trach Care Kit","code_information":[{"code":"4301862","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301862","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Urostomy Mult Wafer","code_information":[{"code":"4302000","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vicryl 2-0 J596","code_information":[{"code":"4302262","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302262","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vicryl 4-0  J823g","code_information":[{"code":"4304045","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304045","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vicryl 4-0 J935h","code_information":[{"code":"4302284","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302284","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vicryl 5-0 J493g","code_information":[{"code":"4302289","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302289","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vicryl 6-0 J492g","code_information":[{"code":"4302256","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302256","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":22,"gross_charge":23,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Oxycodone 5 Mg/5 Ml Sol Ud [Gmh]","code_information":[{"code":"4506073","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383096106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Shoulder Imb, Wmn Xxl","code_information":[{"code":"4302987","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302987","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Tegaderm 2 3/4 X 2 3/4 (C)","code_information":[{"code":"4300549","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300549","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Midazolam 2 Mg/ml 5ml  Syr Ud [Gmh]","code_information":[{"code":"4506021","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687057686","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Warming Blanket (C)","code_information":[{"code":"4302076","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302076","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Allevyn 5x5","code_information":[{"code":"4304036","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304036","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Blunt Access Cannula 18ga X 2.8","code_information":[{"code":"4304107","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304107","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Cath 14fr 2-way W/5cc","code_information":[{"code":"4302014","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302014","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Cath 16fr 2-way W/30ml","code_information":[{"code":"4308907","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308907","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Cath Drain Bag, Leg (C)","code_information":[{"code":"4300391","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300391","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Cervical Collar, Foam, Univ","code_information":[{"code":"4302375","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302375","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Coban 6 Sterile","code_information":[{"code":"4300949","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300949","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Cysto Irrigation Set ( C )","code_information":[{"code":"4300840","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300840","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Disp Uterine Sound 9-3/4","code_information":[{"code":"4303030","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303030","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"E-sep Blade Electrode 125mm","code_information":[{"code":"4301063","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301063","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Iontopatch","code_information":[{"code":"4301833","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301833","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Ligaclip  Med/lg","code_information":[{"code":"4300962","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300962","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Secondary Blood Set","code_information":[{"code":"4400168","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400168","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Shoulder Imb, Mens Xlg","code_information":[{"code":"4302445","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302445","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Shoulder Imb, Mens Xxl","code_information":[{"code":"4302446","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302446","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Ted's, Thigh High Sm","code_information":[{"code":"4302475","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302475","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Ted's, Thigh High Lrg ( C )","code_information":[{"code":"4302477","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302477","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Ted's, Thigh High Xl ( C )","code_information":[{"code":"4302478","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302478","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vacurette Curved 9mm","code_information":[{"code":"4306009","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306009","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vacurette Curved 11mm","code_information":[{"code":"4306011","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vacurette Curved 12mm","code_information":[{"code":"4306012","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vacurette Curved 8mm","code_information":[{"code":"4304055","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304055","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vacurrette Curved 10mm","code_information":[{"code":"4306010","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vicryl 3-0 J322h","code_information":[{"code":"4302283","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302283","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Biatain Silicone 3x3 (C)","code_information":[{"code":"4301837","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Energel Wound Hydrogel (C)","code_information":[{"code":"4300552","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300552","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Comf Wrist Supp L Sm","code_information":[{"code":"4302604","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302604","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Comf Wrist Supp L Med","code_information":[{"code":"4302605","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302605","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Comf Wrist Supp R Sm","code_information":[{"code":"4302609","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302609","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Comf Wrist Supp R Med","code_information":[{"code":"4302610","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302610","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Comf Wrist Supp R Lg","code_information":[{"code":"4302611","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302611","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Rib Belt, Mensuniv","code_information":[{"code":"4302386","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302386","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Vicryl 4-0 J496g","code_information":[{"code":"4302236","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302236","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Omeprazole 20mg Capsule (Prilosec) [Gmh]","code_information":[{"code":"4502812","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268061915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Cyclopentolate Ophth 2%  2 Mlsol [Gmh]","code_information":[{"code":"4500727","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065039702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Imperv Stock Large ( C )","code_information":[{"code":"4301683","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301683","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":21,"gross_charge":22,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":14}]}]},{"description":"Aquacel Ag 2x2 ( C )","code_information":[{"code":"4300447","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300447","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Disp Aux Channel Adaptor (Reorder Awsvalve4-kit #4300165) ( C )","code_information":[{"code":"4300163","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300163","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Simethicone 40 Mg/0.6 Ml Oral Liq [Gmh]","code_information":[{"code":"4503324","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536222075","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nylon 5-0 P3 698h (C)","code_information":[{"code":"4302140","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302140","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Spinal Ndl Pencil 22gax5 (C)","code_information":[{"code":"4304160","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304160","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"0 Pds Ii Pdp334h","code_information":[{"code":"4301728","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301728","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Casting, Roll 4 Synth","code_information":[{"code":"4300354","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300354","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Chromic 1 803h","code_information":[{"code":"4302101","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302101","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Ethilon 3-0 1669h","code_information":[{"code":"4304037","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304037","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 3.5mm","code_information":[{"code":"3500201","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500201","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 4.0mm","code_information":[{"code":"3500202","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500202","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 4.5mm","code_information":[{"code":"3500203","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500203","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 5.0mm","code_information":[{"code":"3500204","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500204","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 5.5mm","code_information":[{"code":"3500285","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500285","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 6.0mm","code_information":[{"code":"3500286","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500286","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 6.5mm","code_information":[{"code":"3500287","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500287","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 7.0mm (C)","code_information":[{"code":"3500288","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500288","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 7.5mm","code_information":[{"code":"3500289","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500289","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oral Rae Tube 8.0mm","code_information":[{"code":"3500282","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500282","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Vicryl 3-0 J497g","code_information":[{"code":"4302231","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302231","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Oxycodone 10 Mg Er Tab [Gmh]","code_information":[{"code":"4503692","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tegaderm 2 X 2 Foam","code_information":[{"code":"4301817","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301817","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Prolene 2-0 Sh 8833h (C)","code_information":[{"code":"4302144","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302144","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Chromic 4-0 G121h (C)","code_information":[{"code":"4302498","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302498","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13}]}]},{"description":"Hydrocortisone Top 1% Crm [Gmh]","code_information":[{"code":"4501283","type":"CDM"},{"code":"250","type":"RC"},{"code":"00472032126","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":20,"gross_charge":21,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ostomy Barrier Seals","code_information":[{"code":"4300709","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300709","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Clopidogrel 75 Mg Tab [Gmh]","code_information":[{"code":"4502215","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084053601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Phenylephrine Ophthalmic 2.5% Sol  2ml [Gmh]","code_information":[{"code":"4505035","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Cath Tray, Plain ( C )","code_information":[{"code":"4300407","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300407","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Baxter Extension Set ( C )","code_information":[{"code":"4400152","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400152","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Amoxicillin 250 Mg/5 Ml Oral Liq [Gmh]","code_information":[{"code":"4500184","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093415579","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Diabetes Outpt Self Management Training, Group Session (Medicare)","code_information":[{"code":"3331958","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"14fr Salem Sump","code_information":[{"code":"4301732","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301732","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"16fr Salem Sump","code_information":[{"code":"4301734","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301734","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"18fr Salem Sump","code_information":[{"code":"4301735","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301735","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Anes- Spnl Ndl 25gax3.5","code_information":[{"code":"3500292","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500292","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Cautery Pad Universal","code_information":[{"code":"4300462","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300462","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Chromic 1 945h","code_information":[{"code":"4302167","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302167","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Chromic 4-0 724g","code_information":[{"code":"4302194","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302194","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Duraprep ( C )","code_information":[{"code":"4300692","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300692","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Ethilon 5-0 698g","code_information":[{"code":"4302047","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302047","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Hydrocellular Foam 6x6 ( C )","code_information":[{"code":"4300780","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300780","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Impervious Stockinette Medium","code_information":[{"code":"4301686","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301686","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Laryngeal Mask #3 Disp","code_information":[{"code":"3500221","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500221","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Laryngeal Mask #4 Disp (C)","code_information":[{"code":"3500226","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500226","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Laryngeal Mask #5 Disp (C)","code_information":[{"code":"3500300","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500300","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Laryngeal Mask # 1.5 Disp","code_information":[{"code":"3500304","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500304","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Needle Spinal 18ga X 6 (C)","code_information":[{"code":"4304184","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304184","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Ob- Electrode, Spiral","code_information":[{"code":"4301073","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301073","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Polysorb 1 Cl925","code_information":[{"code":"4301773","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301773","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Sterile Cotton Webril 6","code_information":[{"code":"4300336","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300336","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Suction Sleeve 165mm","code_information":[{"code":"4301058","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301058","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Suction Sleeve 125mm","code_information":[{"code":"4301059","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301059","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Vicryl 1 J365h","code_information":[{"code":"4302260","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302260","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Epinephrine-lidocaine 1:100000-1% Sol [Gmh]","code_information":[{"code":"4506022","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409317803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine 2%/epinephrine Cartridge1:100,000 [Gmh]","code_information":[{"code":"4507012","type":"CDM"},{"code":"250","type":"RC"},{"code":"00404651205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Montelukast 10 Mg Tab [Gmh]","code_information":[{"code":"4502531","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268057515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Biatain Silicone 6x6 (C)","code_information":[{"code":"4301845","type":"CDM"},{"code":"270","type":"RC"},{"code":"A6213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Chromic 3-0 G122h","code_information":[{"code":"4302192","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302192","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Large Volume Nebulizer","code_information":[{"code":"4302581","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302581","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Simvastatin 20. Mg Tab [Gmh]","code_information":[{"code":"4503169","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084051201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Buprenorphine-naloxone 2 Mg-0.5 Mg Fil [Gmh]","code_information":[{"code":"4506018","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781035503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Trolamine Salicylate Topical 10% Cre [Gmh]","code_information":[{"code":"4507185","type":"CDM"},{"code":"250","type":"RC"},{"code":"00225036011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Spinal Ndl Pencil 22 X 3 1/2 ( C )","code_information":[{"code":"3500215","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500215","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":19,"gross_charge":20,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Kerralite 4x4 (C)","code_information":[{"code":"4300835","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300835","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Dermoplast Spray  78 Gm [Gmh]","code_information":[{"code":"4500811","type":"CDM"},{"code":"250","type":"RC"},{"code":"51409000722","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":78,"type":"GR"}},{"description":"4x5 Super Absorbent Dressing  ( C )","code_information":[{"code":"4300822","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300822","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Microdrip Set","code_information":[{"code":"4400112","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400112","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Pds 1 Z347h","code_information":[{"code":"4301741","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301741","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Bard Cath Drain Bag 4000cc ( C )","code_information":[{"code":"4300394","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300394","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Chromic 2-0 811h","code_information":[{"code":"4302180","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302180","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Chromic 3  #922h","code_information":[{"code":"4302190","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302190","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Ethilon 1 489t","code_information":[{"code":"4302145","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302145","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Laryngeal Mask # 2.5 Disp","code_information":[{"code":"3500224","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500224","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Laryngeal Mask # 1 Disp","code_information":[{"code":"3500305","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500305","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Mini Neolead Electrodes","code_information":[{"code":"4304437","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304437","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Nasal Rae Tube 6.5mm ( C )","code_information":[{"code":"3500242","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500242","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Plain 0 L104g","code_information":[{"code":"4302499","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302499","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Prolene 3-0 8832h (C)","code_information":[{"code":"4302203","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302203","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Prolene 4 #8683g","code_information":[{"code":"4302206","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302206","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Prolene 5 #8661g","code_information":[{"code":"4302209","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302209","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Softflex Endometrial Biopsy Cannula (C)","code_information":[{"code":"4303033","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Spinal Ndl 24ga X 4 Pencan","code_information":[{"code":"3500293","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500293","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Sponge Peanut St","code_information":[{"code":"4301659","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301659","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Tourniquet Cover Lg","code_information":[{"code":"4300168","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300168","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Vicryl 1 J353h","code_information":[{"code":"4301809","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301809","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Vicryl 2-0 J428h","code_information":[{"code":"4302383","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302383","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Budesonide 0.25mg Amp Respules 2ml [Gmh]","code_information":[{"code":"4503563","type":"CDM"},{"code":"250","type":"RC"},{"code":"00115168774","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Barrier Cream 3oz ( C )","code_information":[{"code":"4300965","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300965","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Prolene 3-0 8665g","code_information":[{"code":"4302229","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302229","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":18,"gross_charge":19,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":12}]}]},{"description":"Rifampin 300 Mg Cap [Gmh]","code_information":[{"code":"4505053","type":"CDM"},{"code":"250","type":"RC"},{"code":"00527131506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Risperidone 1. Mg Tab [Gmh]","code_information":[{"code":"4502423","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904635961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Bag Decanter","code_information":[{"code":"4301701","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301701","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Chromic 1 905h","code_information":[{"code":"4302496","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302496","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"K Wire .035","code_information":[{"code":"4306709","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306709","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"K Wire .054","code_information":[{"code":"4306710","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306710","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Medication Label System (C)","code_information":[{"code":"4300983","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300983","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nasal Rae Tube 4.5mm ( C )","code_information":[{"code":"3500256","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500256","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nasal Rae Tube 3.5mm ( C )","code_information":[{"code":"3500257","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500257","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nasal Rae Tube 5mm ( C )","code_information":[{"code":"3500258","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500258","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nasal Rae Tube 6.0mm ( C )","code_information":[{"code":"3500241","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500241","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nasal Rae Tube 7.0mm ( C )","code_information":[{"code":"3500250","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500250","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nasal Rae Tube 7.5mm ( C )","code_information":[{"code":"3500252","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500252","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nasal Rae Tube 8.0mm","code_information":[{"code":"3500268","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500268","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Ob- Delee Mucus Trap","code_information":[{"code":"4301035","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301035","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Pds 0 Z346h","code_information":[{"code":"4301765","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301765","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Plain 2-0 843h","code_information":[{"code":"4302331","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302331","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Prolene 2-0 8417h","code_information":[{"code":"4302202","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302202","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Suture- Chromic 0  #904h","code_information":[{"code":"4302172","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302172","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Nitrofurantoin Macrocrystals 50 Mg Cap [Gmh]","code_information":[{"code":"4501942","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268062315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Escitalopram 10 Mg Tab [Gmh]","code_information":[{"code":"4503650","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079054356","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cefuroxime 250. Mg Tab [Gmh]","code_information":[{"code":"4503988","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180030220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cefdinir 300 Mg Cap Ud [Gmh]","code_information":[{"code":"4507227","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904756304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Prepstick","code_information":[{"code":"4301212","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301212","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":17,"gross_charge":18,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":11}]}]},{"description":"Urea 15 G Pow [Gmh]","code_information":[{"code":"4507183","type":"CDM"},{"code":"250","type":"RC"},{"code":"62530000011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Colchicine 0.6 Mg Tab Ud [Gmh]","code_information":[{"code":"4507188","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904712004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Nasal Rae Tube 5.5mm ( C )","code_information":[{"code":"3500259","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500259","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Ted's, Thigh High Med ( C )","code_information":[{"code":"4302476","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302476","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Nitrofurantoin Macrocrystals-monohydrate 100 Mg Cap [Gmh]","code_information":[{"code":"4501943","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268062515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Phenylephrine Nasal 1% Spray [Gmh]","code_information":[{"code":"4501005","type":"CDM"},{"code":"250","type":"RC"},{"code":"00024135202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metolazone 5 Mg Tab [Gmh]","code_information":[{"code":"4503177","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904732961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bicitra 30ml(sodium Citrate & Citric Acid) Cold  30 Ml [Gmh]","code_information":[{"code":"4500432","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121119000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"20fr 2-way W/30ml","code_information":[{"code":"4302027","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302027","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Anes-skin Sensor Probe (C)","code_information":[{"code":"3500352","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500352","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Bipolar Cord","code_information":[{"code":"4300341","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300341","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Casting, Roll 5 Synth","code_information":[{"code":"4300471","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300471","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Cautery Pencil","code_information":[{"code":"4300461","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300461","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Chloraprep 10.5ml Orange Tint ( C )","code_information":[{"code":"4304052","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304052","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Drain, J P Reservoir","code_information":[{"code":"4300875","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300875","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Magnetic Instrument Drape","code_information":[{"code":"4300645","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300645","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Monocryl Y398h","code_information":[{"code":"4302199","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302199","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Pl Gut 4-0 1824h","code_information":[{"code":"4302230","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302230","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Plain 2-0 H823h","code_information":[{"code":"4302332","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302332","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Premature Biliband","code_information":[{"code":"4301057","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301057","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Regular Biliband","code_information":[{"code":"4301044","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301044","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Suction- Poole Tip","code_information":[{"code":"4301739","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301739","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Tensoplast 3","code_information":[{"code":"4300328","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300328","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"95004 Percut Allergy Skin Tests, Each","code_information":[{"code":"3332423","type":"CDM"},{"code":"521","type":"RC"},{"code":"95004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Betadine Prep Tray (C)","code_information":[{"code":"4301282","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301282","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Triamcinolone Topical 0.1% Oin [Gmh]","code_information":[{"code":"4504106","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tamsulosin 0.4 Mg Cap [Gmh]","code_information":[{"code":"4503362","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084029901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Prolene 0 8412h","code_information":[{"code":"4302228","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302228","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Tegaderm 5 5/8 X 5 5/8 ( C )","code_information":[{"code":"4300547","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300547","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Ethibond 2-0 X964x","code_information":[{"code":"4302326","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302326","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Venlafaxine 37.5 Mg Cap-er [Gmh]","code_information":[{"code":"4504063","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Trilogy Flex Trach Adaptor","code_information":[{"code":"3500296","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500296","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Saline Sterile 1000 Btl ( C )","code_information":[{"code":"4300815","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300815","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Betamethasone Acet&sod Phosp","code_information":[{"code":"3334124","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":16,"gross_charge":17,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Prednisolone Sodium Phosphate 6.7mg/5 Ml Oral Liq 5 Ml  [Gmh]","code_information":[{"code":"4503539","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925016604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":67,"type":"ME"}},{"description":"Pantoprazole 40 Mg Oral Ec Tab [Gmh]","code_information":[{"code":"4503468","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904647461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ciprofloxacin 500 Mg Tab [Gmh]","code_information":[{"code":"4500644","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143992801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"G0008 Flu Shot Charge","code_information":[{"code":"3105070","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Argiment Supplement","code_information":[{"code":"4300196","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300196","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Cath 10fr 2-way W/3ml","code_information":[{"code":"4302010","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Cath 12fr 2-way W/5ml","code_information":[{"code":"4302012","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Cath 16fr 2-way W/5cc","code_information":[{"code":"4302016","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Cath 18fr 2-way W/5ml","code_information":[{"code":"4302018","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Cath 22fr 2-way W/5ml","code_information":[{"code":"4302022","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302022","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Cath 24fr 2-way W/5ml (C)","code_information":[{"code":"4302024","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302024","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Cath 8fr 2-way W/3ml","code_information":[{"code":"4300428","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300428","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Drain, Penrose 1/2","code_information":[{"code":"4301169","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301169","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Dryline Adapter","code_information":[{"code":"4304056","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304056","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Monocryl 2-0 Y945h","code_information":[{"code":"4302354","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302354","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Plain 3-0 873h","code_information":[{"code":"4302497","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302497","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Plaster Casting 5","code_information":[{"code":"4301628","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301628","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Silk 0 Sa86g","code_information":[{"code":"4302264","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302264","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Silk 4  #1677g","code_information":[{"code":"4302257","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302257","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Stylet 2-3.5mm Neonatal","code_information":[{"code":"3500244","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500244","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Tourniquet Cover Sm","code_information":[{"code":"4300167","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300167","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Menthol-zinc Oxide Top 0.44%-20.625% Oint [Gmh]","code_information":[{"code":"4500512","type":"CDM"},{"code":"250","type":"RC"},{"code":"00799000103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":44,"type":"EA"}},{"description":"Quetiapine 25 Mg Tab [Gmh]","code_information":[{"code":"4502017","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054022020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Cath Statlock ( C )","code_information":[{"code":"4300406","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300406","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Water Sterile 1000 Btl ( C )","code_information":[{"code":"4300823","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300823","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Triamcinolone Top 0.1% Crm [Gmh]","code_information":[{"code":"4502876","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breast Pads (24/pkg)","code_information":[{"code":"4301020","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301020","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Drain, Penrose 1/4 (C)","code_information":[{"code":"4301168","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301168","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":15,"gross_charge":16,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":10}]}]},{"description":"Prolene 0-0 Ct1 8424h (C)","code_information":[{"code":"4302139","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302139","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Guaifenesin/codeine Syrup 100mg/10mg/5ml (Robitussin Ac) [Gmh]","code_information":[{"code":"4502442","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121155040","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":100,"type":"ME"}},{"description":"Topiramate 50 Mg Tab [Gmh]","code_information":[{"code":"4506085","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382013914","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":50,"type":"ME"}},{"description":"Vicryl 3-0 J442h ( C )","code_information":[{"code":"4302282","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302282","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Ethibond 1-0 X518h","code_information":[{"code":"4302302","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302302","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Gastro/colon Adaptor Dri-scope","code_information":[{"code":"4301205","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301205","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Doxazosin 2 Mg Tab [Gmh]","code_information":[{"code":"4503594","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079095820","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":2,"type":"ME"}},{"description":"Benzocaine Top 20% Rectal Oint [Gmh]","code_information":[{"code":"4503994","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736003751","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":20,"type":"EA"}},{"description":"Diabetes Education/training For Pt. Self-management, Face To Face With The Pt. 5-8 Pt.","code_information":[{"code":"3331961","type":"CDM"},{"code":"942","type":"RC"},{"code":"98962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Diabetes Education/training For Pt. Self-management, Face To Face With The Pt. 2 Or More","code_information":[{"code":"3331960","type":"CDM"},{"code":"942","type":"RC"},{"code":"98961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Kinrix Charge","code_information":[{"code":"3332437-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90696","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Mmr/varicella Vaccine Charge","code_information":[{"code":"1110136005-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90710","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Allevyn 3x3","code_information":[{"code":"4300698","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300698","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Anes- Esophageal Steth 18","code_information":[{"code":"3500235","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500235","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Casting 4 Red","code_information":[{"code":"4300200","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300200","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Cobalt Penlite (Blue)","code_information":[{"code":"4300528","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300528","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Feeding Tube, Baby #5 (C)","code_information":[{"code":"4300664","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300664","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Feeding Tube, Baby #8","code_information":[{"code":"4300665","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300665","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Foley Holder Leg Band ( C )","code_information":[{"code":"4300396","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300396","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"K Wire 0.062","code_information":[{"code":"4306735","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306735","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Ligaclip Sm/med","code_information":[{"code":"4300960","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300960","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Miltex 3mm Dermal Curette (C)","code_information":[{"code":"4300604","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300604","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Miltex 5mm Dermal Curette ( C )","code_information":[{"code":"4300606","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300606","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Prolene 2-0 8411h","code_information":[{"code":"4302213","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302213","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Prolene 2-0 8685h","code_information":[{"code":"4302255","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302255","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Roll Cotton 1 Lb","code_information":[{"code":"4300317","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300317","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Saline Lock Extender","code_information":[{"code":"4400113","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400113","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Single Use Splint 3 X 12","code_information":[{"code":"4300531","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300531","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Urostomy Bag/drainable 10","code_information":[{"code":"4301995","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301995","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc90700 Dtap","code_information":[{"code":"3332431-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90700","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Bexsero Charge","code_information":[{"code":"3332429-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90620","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Beyfortus Vaccine 50 Mg Charge","code_information":[{"code":"3332377-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90380","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Beyfortus Vaccine 100 Mgcharge","code_information":[{"code":"3332378-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90381","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Beyfortus Vaccine Charge 200 Mg","code_information":[{"code":"3332379-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90381","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Boostrix Charge","code_information":[{"code":"3332430-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90715","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Covid-19 Vaccine (12+ Yr) Charge","code_information":[{"code":"3332356-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"91322","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Covid-19 Vaccine (6 Mo-11yr) Charge","code_information":[{"code":"3332355-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"91321","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Gardasil 9 Charge","code_information":[{"code":"3332432-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90651","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Hepatitis A2 Dose Charge","code_information":[{"code":"3332434-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90633","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Hepatits B Charge","code_information":[{"code":"3332441-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90744","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Hib (Hboc) Pediatric Vaccine Charge","code_information":[{"code":"1110136002-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90648","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Influenza 3 Years + Charge","code_information":[{"code":"3332439-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90656","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Influenza 6-35 Months Charge","code_information":[{"code":"3332433-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90656","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Mcv4 Charge","code_information":[{"code":"3332426-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90734","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Mmr Charge","code_information":[{"code":"3332435-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90707","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Meningococcal Charge","code_information":[{"code":"3332444-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90734","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Pediarix Vaccine Charge","code_information":[{"code":"1110136010-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90723","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Pentacel Charge","code_information":[{"code":"3332443-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90698","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Polio Charge","code_information":[{"code":"3332436-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90713","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Prevnar 13 Charge","code_information":[{"code":"3332438-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90670","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Prevnar 20 Charge","code_information":[{"code":"3332350-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90677","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Rotavirus3 Dose Charge","code_information":[{"code":"3332442-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90680","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Rsv  Abrysvo Vaccine Charge","code_information":[{"code":"3332380-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90678","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Rotavirus (2 Dose) Vaccine Charge","code_information":[{"code":"1110136009-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90681","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vfc Varicella Charge","code_information":[{"code":"3332440-SL","type":"CDM"},{"code":"771","type":"RC"},{"code":"90716","type":"CPT","modifier":"SL"}],"standard_charges":[{"setting":"outpatient","modifier_code":["SL"],"minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Foot Clinic Charge","code_information":[{"code":"3331692","type":"CDM"},{"code":"521","type":"RC"},{"code":"CP3331692","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Acyclovir 400 Mg Tab [Gmh]","code_information":[{"code":"4503383","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268006115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":400,"type":"ME"}},{"description":"Alginate Dressing 2x2 ( C )","code_information":[{"code":"4300827","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300827","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Filter Extension Set (C)","code_information":[{"code":"4400165","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400165","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Tegaderm 4 X  4 1/2 ( C )","code_information":[{"code":"4300546","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300546","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":14,"gross_charge":15,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Nicotine 21 Mg/24 Hr Transderm Er Film [Gmh]","code_information":[{"code":"4501920","type":"CDM"},{"code":"250","type":"RC"},{"code":"00135014502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":21,"type":"ME"}},{"description":"Morphine 10 Mg/0.5ml Oral Conc 0.5 Ml [Gmh]","code_information":[{"code":"4502475","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094005658","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":10,"type":"ME"}},{"description":"Comfort Cushion","code_information":[{"code":"4300510","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300510","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Chromic 2-0 N878h","code_information":[{"code":"4302152","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302152","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Clamp Covers Fabric","code_information":[{"code":"4300861","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300861","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Ent Ear Wick","code_information":[{"code":"4300639","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300639","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Fixodent Adhesive .75 Oz ( C )","code_information":[{"code":"4300573","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300573","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Hibiclens 4oz Btl","code_information":[{"code":"4304507","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304507","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Iodoform 2","code_information":[{"code":"4301019","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301019","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"K Wire .045","code_information":[{"code":"4300982","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300982","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Laryngeal Tube Size 4","code_information":[{"code":"3500301","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500301","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Monocryl 3-0 Y416h","code_information":[{"code":"4301234","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301234","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Oxy- Aqua Pack ( C )","code_information":[{"code":"4302550","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302550","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Prolene 0 8434h (C)","code_information":[{"code":"4302200","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302200","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Stubby Brush","code_information":[{"code":"4301204","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301204","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vicryl 2-0 J461h","code_information":[{"code":"4301636","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301636","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Vicryl 3-0 J285g","code_information":[{"code":"4302291","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302291","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Bacitracin/neomycin/polymyxin B Top Oint 30 Gm [Gmh]","code_information":[{"code":"4500848","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904073431","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":30,"type":"GR"}},{"description":"Amlodipine 5 Mg Tab [Gmh]","code_information":[{"code":"4502005","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268008415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":5,"type":"ME"}},{"description":"Maalox Plus Susp 30ml (200mg/200mg/20mg Per 5ml Magnesium Hydroxide/aluminum Hydroxide/simethicone) [Gmh]","code_information":[{"code":"4501660","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121176130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":30,"type":"ML"}},{"description":"Flex Cysto Adaptors Dri-scope","code_information":[{"code":"4301226","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301226","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Kerrafoam 5x5 ( C )","code_information":[{"code":"4300779","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300779","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Ted's, Knee High 2xl (C)","code_information":[{"code":"4302491","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302491","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":13,"gross_charge":14,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":9}]}]},{"description":"Cholestyramine 4 G/9 G Oral Pwdr [Gmh]","code_information":[{"code":"4503496","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884046565","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Sucrose 24% Soln","code_information":[{"code":"4506010","type":"CDM"},{"code":"250","type":"RC"},{"code":"00906990441","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":24,"type":"EA"}},{"description":"Monocryl 4-0 Y415h","code_information":[{"code":"4301755","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301755","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Povidone Iodine Top 10% Oint 1 Oz  [Gmh]","code_information":[{"code":"4500414","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904110231","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Abdominal Belt Disp ( C )","code_information":[{"code":"4301043","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301043","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Anes-general Purpose Probe","code_information":[{"code":"3500351","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500351","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Arm Sling, Xx-small","code_information":[{"code":"4302361","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302361","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Chromic 3-0 G182h","code_information":[{"code":"4302168","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302168","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Colostomy Wafer 2 3/4","code_information":[{"code":"4300529","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300529","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Connecting Tubing 25ft ( C )","code_information":[{"code":"4302507","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302507","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Douche Set/vag Irrig Set","code_information":[{"code":"4300575","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300575","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Duoderm 4 X 4 Cgf","code_information":[{"code":"4300599","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300599","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Ethilon 3-0 663g","code_information":[{"code":"4302216","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302216","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Iv3000 Dressing 4 X 5 1/2","code_information":[{"code":"4300213","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300213","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Monocryl 1 Y399h","code_information":[{"code":"4302355","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302355","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Oxy- Mask, Non-rebreather ( C )","code_information":[{"code":"4302563","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302563","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Plaster Casting 4","code_information":[{"code":"4300339","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300339","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Ted's, Knee High Sm","code_information":[{"code":"4302479","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302479","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Ted's, Knee High Med ( C )","code_information":[{"code":"4302480","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302480","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Ted's, Knee High Lrg","code_information":[{"code":"4302481","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302481","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Ted's, Knee High Xl (C)","code_information":[{"code":"4302482","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302482","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Vicryl 0  J603h ( C )","code_information":[{"code":"4302272","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302272","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Vicryl 5-0 J421h","code_information":[{"code":"4302350","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302350","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Pravastatin 10 Mg Tab [Gmh]","code_information":[{"code":"4501059","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505016809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Magnesium Citrate 1.745 G/30 Ml Liquid [Gmh]","code_information":[{"code":"4501680","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904741844","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1745,"type":"GR"}},{"description":"Ace 2 Sterile","code_information":[{"code":"4300318","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300318","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Antifog Solution (C)","code_information":[{"code":"4301105","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301105","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Incentive Spirometer ( C )","code_information":[{"code":"4300808","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300808","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Iodoform 1/4","code_information":[{"code":"4301011","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Meloxicam 7.5 Mg Tab [Gmh]","code_information":[{"code":"4501726","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382005001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Ethilon 4-0 662g ( C )","code_information":[{"code":"4302219","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302219","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Vicryl 2-0 J443h","code_information":[{"code":"4302278","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302278","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":12,"gross_charge":13,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":8}]}]},{"description":"Chg Cloth Wipe ( C )","code_information":[{"code":"4300275","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300275","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Coban 2 Sterile","code_information":[{"code":"4300938","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300938","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Indinavir 400. Mg Cap [Gmh]","code_information":[{"code":"4504006","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006057362","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Mexiletine 200 Mg Cap [Gmh]","code_information":[{"code":"4507187","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756095601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Nitroglycerin 2% / 1gm Ointment [Gmh]","code_information":[{"code":"4507153","type":"CDM"},{"code":"250","type":"RC"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Polyethylene Glycol 3350 Oral Pwdr For Recon [Gmh]","code_information":[{"code":"4503589","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574041207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":3350,"type":"EA"}},{"description":"Ace 6 Double ( C )","code_information":[{"code":"4300146","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300146","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Anes- Mask, Adult (Sm) #4 Yellow","code_information":[{"code":"3500233","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500233","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Arm Sling, X-small","code_information":[{"code":"4302360","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302360","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Arm Sling, Small ( C )","code_information":[{"code":"4302362","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302362","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Arm Sling, Medium","code_information":[{"code":"4302363","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302363","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Arm Sling, Large ( C )","code_information":[{"code":"4302364","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302364","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Arm Sling, Xl","code_information":[{"code":"4302365","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302365","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Chromic 0 812h","code_information":[{"code":"4302170","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302170","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Colostomy Drain Bag 1 1/4","code_information":[{"code":"4300525","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300525","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Ethibond 3-0 X832h","code_information":[{"code":"4304046","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304046","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Ethilon 2-0 664g","code_information":[{"code":"4302247","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302247","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Nugauze Pl. 2","code_information":[{"code":"4301016","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301016","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Pds 0 Ii Z352h","code_information":[{"code":"4301743","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301743","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Suction Canister 800cc","code_information":[{"code":"4301726","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301726","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Ted's, Knee High 3xl","code_information":[{"code":"4302490","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302490","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tympanic Temp Probe","code_information":[{"code":"3500349","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500349","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 3-0 J423h","code_information":[{"code":"4301814","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301814","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 4-0 J662h","code_information":[{"code":"4302285","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302285","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Transport Pad 100800","code_information":[{"code":"4302147","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302147","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Pramipexole 0.5 Mg Tab [Gmh]","code_information":[{"code":"4501309","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668009390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Warmer Inserts (C)","code_information":[{"code":"4301258","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301258","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Paroxetine 20 Mg Tab [Gmh]","code_information":[{"code":"4502110","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904567761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ethilon 4-0 P3 662h (C)","code_information":[{"code":"4302143","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302143","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Digoxin 125 Mcg (0.125 Mg) Tab Ud [Gmh]","code_information":[{"code":"4500871","type":"CDM"},{"code":"250","type":"RC"},{"code":"24987024256","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":12,"gross_charge":12,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Vicryl 2-0 J602h","code_information":[{"code":"4302308","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302308","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Mirtazapine 30 Mg Tab [Gmh]","code_information":[{"code":"4503726","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079008720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Doxycycline Hyclate 50 Mg Cap [Gmh]","code_information":[{"code":"4500960","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268027715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nebulizer Adapter (C)","code_information":[{"code":"4300852","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300852","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Warfarin 5 Mg Tab [Gmh]","code_information":[{"code":"4500716","type":"CDM"},{"code":"250","type":"RC"},{"code":"00056017275","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Anes- Mask, Toddler #3 Purple","code_information":[{"code":"3500225","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500225","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Anes- Mask, Adult (Med) #5 Blue","code_information":[{"code":"3500229","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500229","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Asepto Syringe ( C )","code_information":[{"code":"4300205","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300205","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Biopsy Valve Maj-1555","code_information":[{"code":"4300515","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300515","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Casting 3 Red","code_information":[{"code":"4300427","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300427","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Casting, Roll 3 Synth","code_information":[{"code":"4300353","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300353","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Cath Drain Bag","code_information":[{"code":"4300390","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300390","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Contact Lens Removal Kit","code_information":[{"code":"4300757","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300757","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Endogator Jet(do Not Order)","code_information":[{"code":"4301199","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301199","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Ethilon 3-0 669h","code_information":[{"code":"4302329","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302329","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Insyte 24ga X .56","code_information":[{"code":"4400145","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400145","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Little Sucker W/cover","code_information":[{"code":"4301145","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301145","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Neutral Electrode Pad Univ. ( Olympus)","code_information":[{"code":"4300455","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300455","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 0 J207g","code_information":[{"code":"4301618","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301618","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 0 J358h ( C )","code_information":[{"code":"4302297","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302297","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 1 J371h (C)","code_information":[{"code":"4302261","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302261","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 1 J480h ( C )","code_information":[{"code":"4302235","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302235","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 1 Vcp947h","code_information":[{"code":"4302023","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302023","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 2-0 J206g","code_information":[{"code":"4301616","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301616","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 2-0 J266h","code_information":[{"code":"4302233","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302233","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 3-0 J944h","code_information":[{"code":"4301812","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301812","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Misoprostol 200 Mcg Tab [Gmh]","code_information":[{"code":"4507033","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687074601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lactulose 20 G/30 Ml Oral Syrup [Gmh]","code_information":[{"code":"4501522","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121457740","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"GR"}},{"description":"Magnesium Hydroxide 8% Oral Susp 30 Ml [Gmh]","code_information":[{"code":"4501770","type":"CDM"},{"code":"250","type":"RC"},{"code":"69339015317","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Citalopram 20 Mg Tab [Gmh]","code_information":[{"code":"4503200","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904608561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vicryl 3-0 J344h","code_information":[{"code":"4302274","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302274","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Warfarin 3. Mg Tab [Gmh]","code_information":[{"code":"4500743","type":"CDM"},{"code":"250","type":"RC"},{"code":"00056018875","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Midodrine 2.5 Mg Tab [Gmh]","code_information":[{"code":"4503670","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268056415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lanolin Topical 7 Gm Cream [Gmh]","code_information":[{"code":"4506075","type":"CDM"},{"code":"250","type":"RC"},{"code":"44677010202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":7,"type":"GR"}},{"description":"Levetiracetam 250 Mg Tab","code_information":[{"code":"4501008","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268047215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vicryl 2-0 Ctd Vcp259h (C)","code_information":[{"code":"4302141","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302141","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"08290-3065-00-sodium Chloride 0.9% S Oln (Gmh)","code_information":[{"code":"4505013","type":"CDM"},{"code":"250","type":"RC"},{"code":"A4216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Kerrafoam 4x4 ( C )","code_information":[{"code":"4300778","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300778","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Sol Set W/spike Adapter (C)","code_information":[{"code":"4401011","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4401011","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Tegaderm 3 1/2 X 3 1/2 ( C )","code_information":[{"code":"4300545","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300545","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Vicryl 2-0 J945h","code_information":[{"code":"4308908","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308908","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":11,"gross_charge":11,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":7}]}]},{"description":"Scope Brush","code_information":[{"code":"4301272","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301272","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Warfarin 2 Mg Tab [Gmh]","code_information":[{"code":"4500712","type":"CDM"},{"code":"250","type":"RC"},{"code":"00056017075","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Beaver Blade 67","code_information":[{"code":"4300119","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300119","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Ropinirole 0.5 Mg Tab [Gmh]","code_information":[{"code":"4504086","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462025401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Desflurane Per 15 Min","code_information":[{"code":"4501349","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP4501349","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Sevoflurane Per 15 Min","code_information":[{"code":"4501348","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP4501348","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"2-0 Ethilon 1674h","code_information":[{"code":"4304028","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"3-0 Vicryl J215h","code_information":[{"code":"4302301","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302301","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Ace 6 Sterile","code_information":[{"code":"4300148","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300148","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes- Et Tube, Cuff 4.0","code_information":[{"code":"3500272","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500272","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes- Et Tube, Cuff 7.5 ( C )","code_information":[{"code":"3500279","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500279","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes- Et Tube, Cuff 8.0 (C)","code_information":[{"code":"3500280","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500280","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes- Mask, Infant #2 Green","code_information":[{"code":"3500223","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500223","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Bicro Tennis Elbow","code_information":[{"code":"4308939","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308939","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Biopsy 2mm Punch, Disp","code_information":[{"code":"4301028","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301028","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Biopsy Punch 4mm","code_information":[{"code":"4301005","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301005","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Biopsy Punch 5mm","code_information":[{"code":"4301006","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301006","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Biopsy Punch 6mm","code_information":[{"code":"4301007","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301007","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Biopsy Punch 3mm","code_information":[{"code":"4301004","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301004","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Cast Pad, Cotton 6 Nonsterile","code_information":[{"code":"4300316","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300316","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Casting, 2- Blue","code_information":[{"code":"4300307","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300307","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Casting, 2- Red (C)","code_information":[{"code":"4300308","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300308","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Casting, 2- Purple","code_information":[{"code":"4300309","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300309","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Casting, 2- Lime Green","code_information":[{"code":"4300311","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300311","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Cath Kit- 5fr","code_information":[{"code":"4300405","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300405","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Clipper Blade Pivoting ( C )","code_information":[{"code":"4308964","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308964","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Colostomy Wafer 2 3/8","code_information":[{"code":"4301996","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301996","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Combination Cleaning Brush","code_information":[{"code":"4301209","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301209","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Diaper, Size 2","code_information":[{"code":"4301161","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301161","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Ethibond 1 X425h","code_information":[{"code":"4302314","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302314","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Ethibond 2-0 X833h","code_information":[{"code":"4301772","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301772","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Ethilon 6-0 667g ( C )","code_information":[{"code":"4302242","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302242","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Freedom(condom) Catheter","code_information":[{"code":"4301954","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301954","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Gastroccult Test","code_information":[{"code":"4300719","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300719","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Iodoform 1","code_information":[{"code":"4301018","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301018","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Iodoform 1/2","code_information":[{"code":"4301017","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301017","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Nasal Cannula 14ft","code_information":[{"code":"4302508","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302508","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Needle Spinal 22ga X 3 1/2 ( C )","code_information":[{"code":"4304176","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304176","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Needle Spinal 25ga X 3 1/2","code_information":[{"code":"4304178","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304178","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Needle Spinal 18ga X 3 1/2","code_information":[{"code":"4304180","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304180","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Needle Spinal 20ga X 3 1/2","code_information":[{"code":"4304182","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304182","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Non-vented Dispensing Pin","code_information":[{"code":"4400138","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400138","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Ostomy Wafer 1 7/8","code_information":[{"code":"4302003","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Saline Sterile 250 Btl","code_information":[{"code":"4300817","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300817","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Shampoo In A Cap","code_information":[{"code":"4301273","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301273","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Silk 0 680h","code_information":[{"code":"4302250","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302250","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Silk 2 685g","code_information":[{"code":"4302248","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302248","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Single Use Splint 2 X 10","code_information":[{"code":"4300512","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300512","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Spiral Snare 20mm Disp","code_information":[{"code":"4300292","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300292","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Sterile Cotton Webril 4 ( C )","code_information":[{"code":"4300335","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300335","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Surgical Eye Spears","code_information":[{"code":"4300368","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300368","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Tee Valved Adult","code_information":[{"code":"4302544","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302544","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Urostomy Bag 1 3/4","code_information":[{"code":"4302001","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302001","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vial Mate ( C )","code_information":[{"code":"4401121","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4401121","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 0  J958h","code_information":[{"code":"4302104","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302104","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 2-0 Vcp945h","code_information":[{"code":"4302021","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302021","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 2-0 J333h","code_information":[{"code":"4302273","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302273","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 2-0 J339h","code_information":[{"code":"4302276","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302276","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 3-0 J232h","code_information":[{"code":"4301117","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301117","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 3-0 Vcp258h","code_information":[{"code":"4302058","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302058","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 3-0 Vcp416h ( C )","code_information":[{"code":"4302268","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302268","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 3-0 J338h","code_information":[{"code":"4302298","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302298","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 3-0 J356h","code_information":[{"code":"4302353","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302353","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 4-0 J337h ( C )","code_information":[{"code":"4302287","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302287","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 4-0 J643h","code_information":[{"code":"4302295","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302295","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Weespecs Small","code_information":[{"code":"4301064","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301064","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Heparin Flush 10 Units/ml  3ml Sol [Gmh]","code_information":[{"code":"4507191","type":"CDM"},{"code":"250","type":"RC"},{"code":"64253022223","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"UN"}},{"description":"Heparin Flush 100 Units/ml 5 Ml Sol [Gmh]","code_information":[{"code":"4505061","type":"CDM"},{"code":"250","type":"RC"},{"code":"08290306424","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Sodium Chloride 0.9% Flush Inj 5 Ml [Gmh]","code_information":[{"code":"4501847","type":"CDM"},{"code":"250","type":"RC"},{"code":"08290306545","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Sterile Water Inj Sol 20 Ml [Gmh]","code_information":[{"code":"4502606","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323018520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Fluoxetine 20 Mg Cap [Gmh]","code_information":[{"code":"4503658","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904578561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Misoprostol 100 Mcg Tab [Gmh]","code_information":[{"code":"4500721","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687073501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Diphenhydramine 12.5 Mg/5 Ml Oral Liq [Gmh]","code_information":[{"code":"4500890","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687082986","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"10fr Intubating Stylet (C)","code_information":[{"code":"3500299","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500299","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"14fr Intubating Stylet (C)","code_information":[{"code":"3500314","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500314","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"6fr Intubating Stylet","code_information":[{"code":"3500298","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500298","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Little Sucker Nasal Standard","code_information":[{"code":"4301179","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301179","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 0  J340h ( C )","code_information":[{"code":"4302270","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302270","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Bumetanide 0.5mg Tab (Bumex) [Gmh]","code_information":[{"code":"4500476","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238148901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nicotine 14 Mg/24 Hr Transderm Film [Gmh]","code_information":[{"code":"4507120","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536589553","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Nicotine 7 Mg/24 Hr Transderm Film [Gmh]","code_information":[{"code":"4507119","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536589453","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Anes- Airway, Nasal #24 (C)","code_information":[{"code":"3500194","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500194","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes- Airway, Nasal #26 (C)","code_information":[{"code":"3500196","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500196","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes- Airway, Nasal #28 ( C )","code_information":[{"code":"3500198","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500198","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes- Airway, Nasal #30 ( C )","code_information":[{"code":"3500200","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500200","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes- Et Tube, Cuff 3.0","code_information":[{"code":"3500270","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500270","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Mastisol 2/3ml (C)","code_information":[{"code":"4309064","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4309064","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Nasogastric Tube Holder","code_information":[{"code":"3500238","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500238","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vaginal Spec Large","code_information":[{"code":"4303017","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303017","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 0  J346h","code_information":[{"code":"4302271","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302271","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 2-0 J269h","code_information":[{"code":"4302277","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302277","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Injection, Promethazine Hcl,50 Mg","code_information":[{"code":"3331047","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":10,"gross_charge":10,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Nystatin 100,000 Units/ml Oral Susp [Gmh]","code_information":[{"code":"4502028","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121086850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100000,"type":"UN"}},{"description":"Sotalol 80 Mg Tab [Gmh]","code_information":[{"code":"4507182","type":"CDM"},{"code":"250","type":"RC"},{"code":"69584084110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Anes- Et Tube, Cuff 7.0","code_information":[{"code":"3500278","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500278","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 2-0 Vcp602h","code_information":[{"code":"4302321","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302321","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Female Cath Kit ( C )","code_information":[{"code":"4300413","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300413","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 0 J270h","code_information":[{"code":"4301118","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301118","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 1 335h","code_information":[{"code":"4302263","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302263","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes-mini-spike Additive Dispensing Pin","code_information":[{"code":"4401000","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4401000","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Secondary Set W/spike ( C )","code_information":[{"code":"4400123","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400123","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Airway, Oral 70mm White (C)","code_information":[{"code":"3500206","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500206","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Airway, Oral 80mm Green (C)","code_information":[{"code":"3500207","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500207","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Airway, Oral 100mm Red (C)","code_information":[{"code":"3500209","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500209","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Airway, Oral 40mm Pink (C)","code_information":[{"code":"3500211","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500211","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Airway, Oral 50mm Blue (C)","code_information":[{"code":"3500216","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500216","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Flange Tip Yankauer (C)","code_information":[{"code":"4301738","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301738","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Insyte 20ga X 1.88","code_information":[{"code":"4400140","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400140","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Insyte 22ga X 1 (C)","code_information":[{"code":"4400131","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400131","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Insyte 24ga X .75","code_information":[{"code":"4400135","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400135","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Oxy- Cannula Infant (C)","code_information":[{"code":"4302555","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302555","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Sterile Cotton Webril 3 (C)","code_information":[{"code":"4300334","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300334","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Vicryl 2-0 J417h","code_information":[{"code":"4301807","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301807","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Losartan 50. Mg Tab [Gmh]","code_information":[{"code":"4500691","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084034701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ace 4 Sterile","code_information":[{"code":"4300147","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300147","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Hemostat Mesquito Curved","code_information":[{"code":"4304330","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304330","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Nugauze Pl. 1","code_information":[{"code":"4301010","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Silk 0 K834h","code_information":[{"code":"4302309","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302309","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Suction Canister 3000ml","code_information":[{"code":"4308960","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308960","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Zidovudine 100. Mg Cap [Gmh]","code_information":[{"code":"4504018","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084046121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Divalproex Sodium 250 Mg Oral Ec Tab [Gmh]","code_information":[{"code":"4500805","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832712311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ketorolac 10 Mg Tab [Gmh]","code_information":[{"code":"4506077","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093031401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Insyte 18ga X 1.88","code_information":[{"code":"4400149","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400149","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Insyte 18ga X 1.16","code_information":[{"code":"4400148","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400148","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Kerrafoam 3x3 ( C )","code_information":[{"code":"4300777","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300777","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Carvedilol 12.5 Mg Tab [Gmh]","code_information":[{"code":"4503568","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079093120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Carvedilol 6.25 Mg Tab [Gmh]","code_information":[{"code":"4500725","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079093020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Anes- Et Tube, Cuff 3.5","code_information":[{"code":"3500271","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500271","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Anes- Et Tube, Cuff 5.5 (C)","code_information":[{"code":"3500275","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500275","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Coban 3 Sterile","code_information":[{"code":"4300940","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300940","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Ear Currette Lighted","code_information":[{"code":"4308979","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308979","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Insyte 20ga X 1","code_information":[{"code":"4400136","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400136","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Needle Counter/pad ( C )","code_information":[{"code":"4304179","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304179","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Sterile Cotton Webril 2","code_information":[{"code":"4300333","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300333","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Suction- Canister 2000ml ( C )","code_information":[{"code":"4301710","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301710","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":9,"gross_charge":9,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":6}]}]},{"description":"Aersol Drain Bag W/ Tee Adap","code_information":[{"code":"4302511","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302511","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Maxzero Connector (C)","code_information":[{"code":"4400179","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400179","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Anes- High Flow Ext Set","code_information":[{"code":"3500237","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500237","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Airway, Oral 90mm Yellow (C)","code_information":[{"code":"3500208","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500208","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Airway, Oral 60mm Black (C)","code_information":[{"code":"3500205","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500205","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Insyte 14ga","code_information":[{"code":"4400133","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400133","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Comfort Bath Washcloths ( C )","code_information":[{"code":"4300513","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300513","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Ace Elastic 6 ( C )","code_information":[{"code":"4300116","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300116","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Anes- Et Tube, Cuff 4.5","code_information":[{"code":"3500273","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500273","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Lap Sponges ( C )","code_information":[{"code":"4300950","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300950","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Needle Counter 10ct","code_information":[{"code":"4304172","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304172","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Nugauze 1/4","code_information":[{"code":"4301012","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301012","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Plaster Casting 2","code_information":[{"code":"4300337","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300337","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Venlafaxine 37.5 Mg Tab [Gmh]","code_information":[{"code":"4501009","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332000931","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Levothyroxine 50 Mcg (0.05 Mg) Tab [Gmh]","code_information":[{"code":"4502658","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074455211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Spinal Ndl Intro 20g X 1 3/8 ( C )","code_information":[{"code":"3500210","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP3500210","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Glipizide 2.5 Mg Er Tab [Gmh]","code_information":[{"code":"4501223","type":"CDM"},{"code":"250","type":"RC"},{"code":"00049017001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nifedipine 10 Mg Cap [Gmh]","code_information":[{"code":"4503527","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268060015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluticasone-salmeterol 250 Mcg-50 Mcg Inh Pow 60 Puffs [Gmh]","code_information":[{"code":"4507173","type":"CDM"},{"code":"250","type":"RC"},{"code":"00173069600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"K Wire Cover 0.9mm (C)","code_information":[{"code":"4306740","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306740","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"K Wire Cover 1.1mm (C)","code_information":[{"code":"4306739","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306739","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"K Wire Cover 1.6mm (C)","code_information":[{"code":"4306737","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306737","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"K Wire Cover 1.4mm (C)","code_information":[{"code":"4306738","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306738","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Colostomy Wafer 1 1/4","code_information":[{"code":"4300519","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300519","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Nugauze Pl. 1/2","code_information":[{"code":"4301013","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301013","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Oxy Mask Pedi Non-reb","code_information":[{"code":"4302570","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302570","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Suction Tray 12fr","code_information":[{"code":"4301745","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301745","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"T-adapter W/valve","code_information":[{"code":"4302573","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302573","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Fenofibrate 48 Mg Tab [Gmh]","code_information":[{"code":"4502808","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687061821","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Cavilon Wand (C)","code_information":[{"code":"4300118","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300118","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Anes- Et Tube, Cuff 6.0","code_information":[{"code":"3500276","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500276","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Colostomy Drain 2 3/4","code_information":[{"code":"4300523","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300523","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Hemostat Mosquito Straight","code_information":[{"code":"4304331","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304331","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Raytec ( C )","code_information":[{"code":"4301657","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301657","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Silk 3-0 K832h","code_information":[{"code":"4302232","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302232","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Skin Stapler Remover","code_information":[{"code":"4301285","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301285","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":5}]}]},{"description":"Acetaminophen 120 Mg Supp [Gmh]","code_information":[{"code":"4503918","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802073230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Acetaminophen 650 Mg Supp [Gmh]","code_information":[{"code":"4500024","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802073030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Acetaminophen-codeine 300 Mg-30 Mg Tab [Gmh]","code_information":[{"code":"4500023","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406048462","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Acetaminophen-hydrocodone 325 Mg-10 Mg Tab [Gmh]","code_information":[{"code":"4503206","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687041801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Advanced Probiotic-14[gmh]","code_information":[{"code":"4507222","type":"CDM"},{"code":"250","type":"RC"},{"code":"40093010166","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":14,"type":"EA"}},{"description":"Albuterol 0.083% Inh Sol 3 Ml [Gmh]","code_information":[{"code":"4500078","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335070352","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Allopurinol 100 Mg Tab [Gmh]","code_information":[{"code":"4500110","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079020520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Aluminum Chloride 20% Solution [Gmh]","code_information":[{"code":"4505025","type":"CDM"},{"code":"250","type":"RC"},{"code":"00096070737","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Amitriptyline 10 Mg Tab [Gmh]","code_information":[{"code":"4500162","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268003715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amitriptyline 25 Mg Tab [Gmh]","code_information":[{"code":"4500154","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687043301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amoxicillin 250 Mg Cap [Gmh]","code_information":[{"code":"4500177","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687077601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Argiment At [Gmh]","code_information":[{"code":"4507022","type":"CDM"},{"code":"250","type":"RC"},{"code":"94688012201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atenolol 25 Mg Tab","code_information":[{"code":"4502718","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904718761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atorvastatin 20 Mg Tab [Gmh]","code_information":[{"code":"4501603","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904629161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Atropine-diphenoxylate 0.025 Mg-2.5 Mg Tab [Gmh]","code_information":[{"code":"4501615","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406123601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bacitracin Topical Zinc 500 Units/g Oin Ud [Gmh]","code_information":[{"code":"4500359","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904702367","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":500,"type":"UN"}},{"description":"Bacitracin/neomycin/polymyxin B Top Oint 0.9 Gm [Gmh]","code_information":[{"code":"4501887","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904880567","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":9,"type":"GR"}},{"description":"Banatrol Plus [Gmh]","code_information":[{"code":"4506052","type":"CDM"},{"code":"250","type":"RC"},{"code":"94688018470","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Benztropine 0.5 Mg Tab [Gmh]","code_information":[{"code":"4500424","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084038101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bisacodyl 10 Mg Supp [Gmh]","code_information":[{"code":"4500435","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574705050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bisacodyl 5 Mg Oral Ec Tab [Gmh]","code_information":[{"code":"4500431","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904640761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Buspirone 5 Mg Tab  [Gmh]","code_information":[{"code":"4507167","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079098520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Calcium Carbonate 1250 Mg (Calcium 500mg) Tab [Gmh]","code_information":[{"code":"4500123","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904188361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1250,"type":"ME"}},{"description":"Calcium-vitamin D 600 Mg-200 Units Tab [Gmh]","code_information":[{"code":"4500510","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681013800","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Carbamazepine 100 Mg Tab (Gmh)","code_information":[{"code":"4503020","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904385461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Carbidopa-levodopa 25 Mg-100 Mg Er Tab [Gmh]","code_information":[{"code":"4502533","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084028101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carbidopa-levodopa 25 Mg-100 Mg Tab","code_information":[{"code":"4502532","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904750161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carbidopa-levodopa 25 Mg-250 Mg Tab","code_information":[{"code":"4502534","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687083601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carisoprodol 350 Mg Tab [Gmh]","code_information":[{"code":"4501073","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739004910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Cephalexin 250 Mg Cap [Gmh]","code_information":[{"code":"4500597","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Chlordiazepoxide 25 Mg Cap [Gmh]","code_information":[{"code":"4503302","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079014120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Cholecalciferol 125 Mcg (5,000 Iu) Tab Ud [Gmh]","code_information":[{"code":"4507055","type":"CDM"},{"code":"250","type":"RC"},{"code":"54629794101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Cholecalciferol 25 Mcg (1000 Intunits) Oral Tablet [Gmh]","code_information":[{"code":"4501038","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681016800","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clindamycin 150 Mg Cap Ud [Gmh]","code_information":[{"code":"4506093","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904595961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Clonazepam 0.5 Mg Tab [Gmh]","code_information":[{"code":"4503716","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687054401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clonidine 0.1 Mg Tab {Gmh]","code_information":[{"code":"4505037","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687011301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyanocobalamin 500 Mcg Tab [Gmh]","code_information":[{"code":"4502760","type":"CDM"},{"code":"250","type":"RC"},{"code":"20555003200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cyclobenzaprine 10 Mg Tab [Gmh]","code_information":[{"code":"4500739","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687055801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dexamethasone 4 Mg Tab Ud [Gmh]","code_information":[{"code":"4507014","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054817525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Diazepam 5 Mg Tab [Gmh]","code_information":[{"code":"4500861","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dicyclomine 10 Mg Cap [Gmh]","code_information":[{"code":"4503316","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687036901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diltiazem 120 Mg/24 Hours Ercap [Gmh]","code_information":[{"code":"4503940","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904721761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Diltiazem 180 Mg/24 Hours Ercap [Gmh]","code_information":[{"code":"4503899","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904721861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Doxepin 25 Mg Cap [Gmh]","code_information":[{"code":"4502540","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079043720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ethyl Chloride Topical 100% Spr [Gmh]","code_information":[{"code":"4507142","type":"CDM"},{"code":"250","type":"RC"},{"code":"00386000111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Famotidine 20 Mg Tab [Gmh]","code_information":[{"code":"4502130","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687059501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ferrous Sulfate 325 Mg Tab [Gmh]","code_information":[{"code":"4501107","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904759161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Finasteride 5 Mg Tab Ud [Gmh]","code_information":[{"code":"4507093","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687042865","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fludrocortisone 0.1 Mg Tab","code_information":[{"code":"4507212","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904731706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fluorescein Ophthalmic 1. Mg Test [Gmh]","code_information":[{"code":"4501228","type":"CDM"},{"code":"250","type":"RC"},{"code":"17238090011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Folic Acid 1 Mg Tab [Gmh]","code_information":[{"code":"4501137","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687068101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Furosemide 40 Mg Tab [Gmh]","code_information":[{"code":"4501144","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904717861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Gabapentin 100 Mg Cap [Gmh]","code_information":[{"code":"4501890","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687058001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gabapentin 300 Mg Cap [Gmh]","code_information":[{"code":"4501901","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739090310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Glimepiride 2 Mg Tab [Gmh]","code_information":[{"code":"4503697","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084032601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Glipizide 5 Mg Tab [Gmh]","code_information":[{"code":"4501178","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904663761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Guaifenesin 600 Mg Er Tab [Gmh]","code_information":[{"code":"4501196","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084057201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Haloperidol 0.5 Mg Tab [Gmh]","code_information":[{"code":"4501218","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079073320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydralazine 10 Mg Tab [Gmh]","code_information":[{"code":"4501270","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079007420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hydrochlorothiazide 25 Mg Tab [Gmh]","code_information":[{"code":"4501276","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687059301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydrochlorothiazide-triamterene 25 Mg-37.5 Mg Cap [Gmh]","code_information":[{"code":"4502867","type":"CDM"},{"code":"250","type":"RC"},{"code":"00527163201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydrocodone/acetaminophen 5mg/325mg (Norco 5/325) 1, Tab [Gmh]","code_information":[{"code":"4501274","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406012362","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydromorphone 2 Mg Tab Ud [Gmh]","code_information":[{"code":"4506061","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858030101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Hydromorphone 4 Mg Tab [Gmh]","code_information":[{"code":"4502008","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858030201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Hydroxyzine Pamoate 25 Mg Cap Ud [Gmh]","code_information":[{"code":"4506035","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904706561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hyoscyamine 0.125 Mg Dis Tab [Gmh]","code_information":[{"code":"4501558","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559042201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ibuprofen 600. Mg Tab [Gmh]","code_information":[{"code":"4501343","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687045701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Ibuprofen 800. Mg Tab [Gmh]","code_information":[{"code":"4501066","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904585561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Indomethacin 25 Mg Cap [Gmh]","code_information":[{"code":"4501370","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268043015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ipratropium 0.02% Inh Sol 2.5 Ml [Gmh]","code_information":[{"code":"4501332","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204010060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Ipratropium Bromide 0.5mg/ Albuterol 3mg  3 Ml, Inhalant [Gmh]","code_information":[{"code":"4500079","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687040583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Isosorbide Dinitrate 10 Mg Tab [Gmh]","code_information":[{"code":"4501442","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904661961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Isosorbide Mononitrate 30 Mg Er Tab [Gmh]","code_information":[{"code":"4501446","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904644961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Labetalol 100 Mg Tab [Gmh]","code_information":[{"code":"4507156","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904745161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Levetiracetam 500 Mg Tab Ud (Gmh)","code_information":[{"code":"4507148","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687065701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levothyroxine 100 Mcg (0.1 Mg) Tab [Gmh]","code_information":[{"code":"4502648","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687049701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Levothyroxine 150 Mcg (0.15 Mg) Tab [Gmh]","code_information":[{"code":"4502646","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687053001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Levothyroxine 88 Mcg (0.088 Mg) Tab [Gmh]","code_information":[{"code":"4503197","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904695261","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":88,"type":"ME"}},{"description":"Lidocaine  Viscous Soln 2% Ud  [Gmh]","code_information":[{"code":"4501588","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lisinopril 10 Mg Tab [Gmh]","code_information":[{"code":"4503741","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904679861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Loperamide 2 Mg Tab [Gmh]","code_information":[{"code":"4503959","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660012312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Loratadine 10 Mg Tab [Gmh]","code_information":[{"code":"4500652","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084024801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lorazepam 0.5 Mg Tab [Gmh]","code_information":[{"code":"4501621","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687082001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Magnesium Oxide 400 Mg Tab [Gmh]","code_information":[{"code":"4501687","type":"CDM"},{"code":"250","type":"RC"},{"code":"68585000641","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Meclizine 12.5 Mg Tab [Gmh]","code_information":[{"code":"4501709","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268052215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Medroxyprogesterone 2.5 Mg Tab [Gmh]","code_information":[{"code":"4502350","type":"CDM"},{"code":"250","type":"RC"},{"code":"00555087202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metformin 500 Mg Er Tab Ud [Gmh]","code_information":[{"code":"4507056","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010049101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformin 500 Mg Tab [Gmh]","code_information":[{"code":"4501177","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904716261","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metoclopramide 5. Mg Tab [Gmh]","code_information":[{"code":"4501728","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079088620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Metoprolol Succ 25 Mg Er Tab [Gmh]","code_information":[{"code":"4501097","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687039001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metoprolol Tart 25 Mg Tab [Gmh]","code_information":[{"code":"4500185","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079025520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metronidazole 250 Mg Tab","code_information":[{"code":"4501740","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687052601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Multiple Vitamins Tab [Gmh]","code_information":[{"code":"4501821","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904053061","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naproxen 500 Mg Tab [Gmh]","code_information":[{"code":"4504110","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687049101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nifedipine Er 30 Mg Tab {Gmh]","code_information":[{"code":"4507172","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084059701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Nitroglycerin 0.4 Mg Sublingual Tab [Gmh]","code_information":[{"code":"4501946","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598043611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ocean Nasal Spray (0.65% Sodium Chloride) Saline Mist 45 Ml, Nasal Spray [Gmh]","code_information":[{"code":"4502026","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802035758","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":45,"type":"ML"}},{"description":"Oxybutynin 5 Mg Tab [Gmh]","code_information":[{"code":"4503997","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904702761","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxycodone 5 Mg Tab [Gmh]","code_information":[{"code":"4501052","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084035401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxycodone/acetaminophen 5 Mg-325 Mg Tab [Gmh]","code_information":[{"code":"4502135","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406051262","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pentafluoropropane-tetrafluoroethane Topicalspr [Gmh}","code_information":[{"code":"4501319","type":"CDM"},{"code":"250","type":"RC"},{"code":"00386000802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phenazopyridine 97.5 Mg Tab","code_information":[{"code":"4505082","type":"CDM"},{"code":"250","type":"RC"},{"code":"49973024412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":975,"type":"ME"}},{"description":"Phenobarbital 32.4 Mg Tab [Gmh]","code_information":[{"code":"4502180","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739020115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":324,"type":"ME"}},{"description":"Phenytoin Sodium Cap 100mg (Dilantin) [Gmh]","code_information":[{"code":"4503350","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687084101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Potassium Chloride 10 Meq Tab","code_information":[{"code":"4502243","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904721661","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"UN"}},{"description":"Prednisone 1 Mg Tab [Gmh]","code_information":[{"code":"4502271","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380078206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Prednisone 10 Mg Tab [Gmh]","code_information":[{"code":"4502256","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904692361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prenatal Multivitamins With Folic Acid 1 Mg Tab [Gmh]","code_information":[{"code":"4502338","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811000710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Promethazine 25. Mg Tab [Gmh]","code_information":[{"code":"4503217","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746052101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Propafenone 150. Mg Tab [Gmh]","code_information":[{"code":"4503813","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687093001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Propranolol 10. Mg Tab [Gmh]","code_information":[{"code":"4502321","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268066215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pseudoephedrine 30. Mg Tab [Gmh]","code_information":[{"code":"4502625","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904699061","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Psyllium Husk 3.4gm (Metamucil Powder Pkt ) [Gmh]","code_information":[{"code":"4501731","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000002404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":34,"type":"GR"}},{"description":"Senna 8.6 Mg Tab [Gmh]","code_information":[{"code":"4502528","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904652261","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":86,"type":"ME"}},{"description":"Senna S (Docusate Sodium 50mg/ Sennosides 8.6mg) 1, Tab [Gmh]","code_information":[{"code":"4503278","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687062201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sertraline 100 Mg Tab [Gmh]","code_information":[{"code":"4503159","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687025301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Silver Nitrate Topical Stick [Gmh]","code_information":[{"code":"4502525","type":"CDM"},{"code":"250","type":"RC"},{"code":"12870000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sodium Biphosphate-sodium Phosphate 19 G-7 G Enema [Gmh]","code_information":[{"code":"4501123","type":"CDM"},{"code":"250","type":"RC"},{"code":"00132020140","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":19,"type":"GR"}},{"description":"Sodium Chloride 1 G Tab Ud [Gmh]","code_information":[{"code":"4507186","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904723961","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Spironolactone 25. Mg Tab [Gmh]","code_information":[{"code":"4502595","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079010320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sucralfate 1. Gm Tab [Gmh]","code_information":[{"code":"4502632","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079075320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Sulfameth/trimeth Tab 800mg/160mg [Gmh]","code_information":[{"code":"4502639","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904272561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sulfasalazine 500. Mg Tab [Gmh]","code_information":[{"code":"4503938","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762500005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tetracaine Ophth 0.5% Sol 4 Ml [Gmh]","code_information":[{"code":"4505071","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065074114","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Theophylline 400 Mg/24 Hours Tab [Gmh]","code_information":[{"code":"4505067","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462038001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Thiamine Tab 100mg (Vitamin B-1) [Gmh]","code_information":[{"code":"4502766","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268085115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Torsemide 20. Mg Tab [Gmh]","code_information":[{"code":"4500786","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904728306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tramadol 50 Mg Tab [Gmh]","code_information":[{"code":"4503751","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904749661","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Trazodone 50. Mg Tab [Gmh]","code_information":[{"code":"4502861","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687044301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vitamin A 10000. Unit(s) Cap [Gmh]","code_information":[{"code":"4501040","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904208560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":10000,"type":"UN"}},{"description":"Zolpidem 5 Mg Tab [Gmh]","code_information":[{"code":"4501347","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904608261","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":8,"gross_charge":8,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Omni-felx Connector","code_information":[{"code":"4302582","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302582","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"10fr Salem Sump","code_information":[{"code":"4301729","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301729","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Free Needle(keith Ndl)","code_information":[{"code":"4305051","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4305051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Sweet Ease","code_information":[{"code":"4304128","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304128","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Disposable Endoscope  Mouthpiece ( C )","code_information":[{"code":"4301211","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301211","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"250ml Sterile Water Btl","code_information":[{"code":"4300841","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300841","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Anes- Et Tube, Uncuff 3.0","code_information":[{"code":"3500261","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500261","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Anes- Et Tube, Cuff 5.0","code_information":[{"code":"3500274","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500274","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Anes- Et Tube, Cuff 6.5 (C)","code_information":[{"code":"3500277","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500277","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Bioclusive 4 X 5","code_information":[{"code":"4300239","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300239","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Cast Pad, Cotton 4 Nonsterile","code_information":[{"code":"4300314","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300314","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Coban 4 Sterile","code_information":[{"code":"4300939","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300939","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Duoderm 4x4 Xthin","code_information":[{"code":"4300594","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300594","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Enema Kit ( C )","code_information":[{"code":"4300628","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300628","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Iol Guide","code_information":[{"code":"4300430","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300430","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"K-y Jelly 4 Oz Tube","code_information":[{"code":"4300912","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300912","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Montogomery Strap","code_information":[{"code":"4308984","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308984","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Stax Finger Splint #5","code_information":[{"code":"4301974","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301974","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Stax Finger Splint #4","code_information":[{"code":"4301972","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301972","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Suction Tray 10fr","code_information":[{"code":"4301744","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301744","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Urine Collection- Mid Stream (C)","code_information":[{"code":"4301936","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301936","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Vaginal Spec Medium","code_information":[{"code":"4301945","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301945","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Vaginal Spec Small","code_information":[{"code":"4301948","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301948","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"22f-22m Connector","code_information":[{"code":"4302526","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302526","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Cervical Collar, Extender","code_information":[{"code":"4302384","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302384","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Silk 2 Sa8h","code_information":[{"code":"4302359","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302359","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Vicryl 4-0 Vcp214h (C)","code_information":[{"code":"4302294","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302294","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"12fr Salem Sump","code_information":[{"code":"4301730","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301730","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Ace 3 Sterile","code_information":[{"code":"4300268","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300268","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Airway, Oral 30mm Clear","code_information":[{"code":"3500214","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500214","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Cast Pad, Synth 6 Roll","code_information":[{"code":"4300306","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300306","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Mucous Trap","code_information":[{"code":"4300993","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300993","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":7,"gross_charge":7,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Suction Tubing 7mm ( Surgery Only ) ( C )","code_information":[{"code":"4301722","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301722","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Tender Care Hydrogel","code_information":[{"code":"4301039","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301039","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Kerlix Lg 4.5x 4.1 Yd ( C )","code_information":[{"code":"4300880","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300880","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Circumcision Strap(disp) ( C )","code_information":[{"code":"4300496","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300496","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Ob- Electrode, Adh Pad","code_information":[{"code":"4301079","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301079","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Oxy- Cannula (Pediatric)","code_information":[{"code":"4302554","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302554","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"90474 Each Additional Vaccine By Intranasal Or Oral Route","code_information":[{"code":"3331063","type":"CDM"},{"code":"510","type":"RC"},{"code":"90474","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Aeroeclipse Mask Md","code_information":[{"code":"4302520","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302520","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Splint, Finger Aluminum","code_information":[{"code":"4308986","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308986","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Sterile 16oz Bowl","code_information":[{"code":"4300089","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300089","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Sterile Spoon 2.5ml","code_information":[{"code":"4301243","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301243","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Anes- Et Tube, Uncuff 5.0","code_information":[{"code":"3500265","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500265","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Anes- Et Tube, Uncuff 6.0","code_information":[{"code":"3500267","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500267","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Ez-hold Standard","code_information":[{"code":"4301146","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301146","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Face Tent Oxy Mask","code_information":[{"code":"4302500","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302500","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Irrigation Tray","code_information":[{"code":"4300845","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300845","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Mini Blade 64","code_information":[{"code":"4300262","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300262","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Moleskin","code_information":[{"code":"4300600","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300600","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Needle Spinal 22ga X 2 1/2","code_information":[{"code":"4304177","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304177","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Scissor Iris Straight 4 1/2","code_information":[{"code":"4304329","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304329","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Sterile Lubricating Jelly ( C )","code_information":[{"code":"4300915","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300915","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Trach Mask Adult","code_information":[{"code":"4302580","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302580","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Vicryl 4-0 J415h","code_information":[{"code":"4301813","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301813","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":6,"gross_charge":6,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":4}]}]},{"description":"Medipore +Pad 3 1/2 X 4","code_information":[{"code":"4301821","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301821","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"5fr Straight Cath (C)","code_information":[{"code":"4302045","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302045","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Ace Elastic 3 ( C )","code_information":[{"code":"4300113","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300113","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Ace Elastic 4 ( C )","code_information":[{"code":"4300114","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300114","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Anes- Et Tube, Uncuff 2.5","code_information":[{"code":"3500260","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500260","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Anes- Et Tube, Uncuff 3.5","code_information":[{"code":"3500262","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500262","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Anes- Et Tube, Uncuff 4.0","code_information":[{"code":"3500263","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500263","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Anes- Et Tube, Uncuff 4.5","code_information":[{"code":"3500264","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500264","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Anes- Et Tube 5.5 Uncuff","code_information":[{"code":"3500266","type":"CDM"},{"code":"370","type":"RC"},{"code":"CP3500266","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Baxter Secondary Set ( Old One )","code_information":[{"code":"4400141","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400141","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Colostomy Wafer 1 3/4","code_information":[{"code":"4300673","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300673","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Needle- Butterfly 21x3/4","code_information":[{"code":"4400161","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400161","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Suctiontubing ( C )","code_information":[{"code":"4301716","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301716","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Oxy- Minineb Adult ( C )","code_information":[{"code":"4302572","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302572","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Chloraprep 3ml Orange (C)","code_information":[{"code":"4303010","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4303010","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Channel Opening Brush","code_information":[{"code":"4301208","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301208","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Oxy- Mask, Aerosol Pedi","code_information":[{"code":"4302574","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302574","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Urgotul 2x2 (C)","code_information":[{"code":"4301830","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301830","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Cast Pad, Synth 4 Roll","code_information":[{"code":"4300304","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300304","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Hibiclens Pkts ( C )","code_information":[{"code":"4304504","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304504","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Sleeve, Sterile","code_information":[{"code":"4301290","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301290","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Suction- Yankauer Finetip","code_information":[{"code":"4301742","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301742","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Anoscope (Disposable)","code_information":[{"code":"4300152","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300152","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Newborn Ambu Mask","code_information":[{"code":"4300288","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300288","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Shower Shield 7 X 7","code_information":[{"code":"4300247","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300247","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}]},{"description":"Diphenhydramine/ Up To 50mg Im","code_information":[{"code":"3331044","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Injection, Ketorolac Tromethamine Charge","code_information":[{"code":"3334203","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Cast Pad, Cotton 2 Nonsterile","code_information":[{"code":"4300312","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300312","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Suture Removal Kit","code_information":[{"code":"4304328","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304328","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Umbilical Tape U10t","code_information":[{"code":"4301767","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301767","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"10fr Straight Cath ( C )","code_information":[{"code":"4302049","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302049","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"12fr Straight Cath ( C )","code_information":[{"code":"4302050","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302050","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"14fr Straight Cath","code_information":[{"code":"4302051","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302051","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"16fr Straight Cath ( C )","code_information":[{"code":"4302052","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302052","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"18fr Straight Cath","code_information":[{"code":"4302053","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302053","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"2x2 Gauze","code_information":[{"code":"4306717","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306717","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"3x3 Gauze Sponge Sterile","code_information":[{"code":"4300708","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300708","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"3x3 Guaze","code_information":[{"code":"4306718","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306718","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"3x8 Non Adhering Oil Dressing","code_information":[{"code":"4300942","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300942","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"8fr Straight Cath","code_information":[{"code":"4302048","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302048","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Ace Elastic 2","code_information":[{"code":"4300112","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300112","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Aeroeclipse Adapter","code_information":[{"code":"4302521","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302521","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Armboard, Iv Pedi","code_information":[{"code":"4400107","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400107","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Betadine Swabstick 3's","code_information":[{"code":"4300243","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300243","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Blade #12","code_information":[{"code":"4300252","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300252","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Blade #20","code_information":[{"code":"4300256","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300256","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Brief2xl","code_information":[{"code":"4300283","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300283","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Brieflarge","code_information":[{"code":"4300227","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300227","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Briefmedium","code_information":[{"code":"4300226","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300226","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Briefxl","code_information":[{"code":"4300289","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300289","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Bulb Syringe ( C )","code_information":[{"code":"4300285","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300285","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cast Pad, Cotton 3 Nonsterile","code_information":[{"code":"4300313","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300313","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cast Pad, Synth 2 Roll","code_information":[{"code":"4300302","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300302","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cast Pad, Synth 3 Roll","code_information":[{"code":"4300303","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300303","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Casting, Splint 3 Xfast","code_information":[{"code":"4300346","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300346","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cath Adapter","code_information":[{"code":"4300398","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300398","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cath Clamp","code_information":[{"code":"4300397","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300397","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cautery Cleaning Pad","code_information":[{"code":"4300459","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300459","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Chg Scrub Brush","code_information":[{"code":"4300301","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300301","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Colostomy Clip","code_information":[{"code":"4300169","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300169","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Colostomy Drain Bag 1 3/4","code_information":[{"code":"4300674","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300674","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Colostrum Container 35ml","code_information":[{"code":"4304118","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304118","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Combine Pad 5 X 9","code_information":[{"code":"4300101","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300101","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Connecting Tubing 14 ( C )","code_information":[{"code":"4302557","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302557","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Connecting Tubing 7 (C)","code_information":[{"code":"4302571","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302571","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Diaper Size 1","code_information":[{"code":"4301157","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301157","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Diaper, Newborn","code_information":[{"code":"4301156","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301156","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Diaper, Preemie","code_information":[{"code":"4301158","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301158","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Diaper, Size 3","code_information":[{"code":"4301155","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301155","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Diaper, Size 4","code_information":[{"code":"4301159","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301159","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Duraprep Remover","code_information":[{"code":"4300693","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300693","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"E-z Wrap Pair","code_information":[{"code":"4302559","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302559","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Electrode Diaphoretic (C)","code_information":[{"code":"4304439","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304439","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Electrodes, Neonatal","code_information":[{"code":"4304445","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304445","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Eye Pad","code_information":[{"code":"4300649","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300649","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Hemorrhoidal O Bands","code_information":[{"code":"4308900","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308900","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Kerlix Lite 3x 4 Yd","code_information":[{"code":"4300881","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300881","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Kerlix Sm 2.25x 9'","code_information":[{"code":"4300882","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300882","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Kerlix Super Sponge","code_information":[{"code":"4300883","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300883","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Lemon Glycerin Swabs","code_information":[{"code":"4300958","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300958","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Lock Cannula","code_information":[{"code":"4400164","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400164","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Neonatal Velcro Wrap","code_information":[{"code":"4306003","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4306003","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Non Adhering 3 X 3","code_information":[{"code":"4300876","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300876","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Non Adhering Dressing 2 X 3","code_information":[{"code":"4301828","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301828","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Ob- Amnihook (C)","code_information":[{"code":"4301033","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301033","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Ob- Cord Clamp","code_information":[{"code":"4301029","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301029","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Oxy- Cannula (Adult)","code_information":[{"code":"4302553","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302553","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Oxy- Mask, Aerosol ( C )","code_information":[{"code":"4302560","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302560","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Oxygen Adapter","code_information":[{"code":"4302515","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302515","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Peri Pads Each","code_information":[{"code":"4301062","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301062","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Razor, Blue (Disp)","code_information":[{"code":"4301230","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301230","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Razor, Prep","code_information":[{"code":"4301231","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301231","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Scrub Brush Plain","code_information":[{"code":"4301266","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301266","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Shower Cap","code_information":[{"code":"4308906","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4308906","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Silk 2-0 K833h (C)","code_information":[{"code":"4302299","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302299","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Skin Marker, Sterile ( C )","code_information":[{"code":"4301284","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301284","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Steri-strip Elastic 1/4","code_information":[{"code":"4301749","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301749","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Steri-strip Elastic 1/8","code_information":[{"code":"4301750","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301750","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Sterile Wrap 30 X 30","code_information":[{"code":"4304438","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304438","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Stopcock, Three-way (C)","code_information":[{"code":"4400181","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4400181","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Suctionyankauer Tip ( C )","code_information":[{"code":"4301736","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301736","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Suction Catheter 10fr (C)","code_information":[{"code":"4301706","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301706","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Suction- Catheter 8fr","code_information":[{"code":"4301711","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301711","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Suction- Catheter 12fr (C)","code_information":[{"code":"4301712","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301712","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Suction- Catheter 14fr","code_information":[{"code":"4301713","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301713","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Telfa 8 X 3","code_information":[{"code":"4301824","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301824","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Tinc Benzoin Amp","code_information":[{"code":"4301676","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301676","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Ultra Fine Tip Retractable Marker","code_information":[{"code":"4301286","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301286","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Urine Coll- Pedi Bag","code_information":[{"code":"4301939","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301939","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Vial Decanter (C)","code_information":[{"code":"4301704","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301704","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Vicryl 2-0 J317h","code_information":[{"code":"4302280","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4302280","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Xeroform 1 X 8","code_information":[{"code":"4304376","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4304376","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Cath Plug, Sterile","code_information":[{"code":"4300403","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4300403","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Fine Tip Skin Marker (C)","code_information":[{"code":"4301287","type":"CDM"},{"code":"270","type":"RC"},{"code":"CP4301287","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}]},{"description":"Injection, Vitamin B-12 Cyanocobalamin,  Up To 1000 Mcg","code_information":[{"code":"3331048","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"J3301 Inj, Triamcinolone Acetonide, Per 10mg Charge","code_information":[{"code":"3335005","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"J0696 Rocephin Inj 1 Gm","code_information":[{"code":"3332258","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Acetaminophen 160 Mg/5 Ml Liq Ud [Gmh]","code_information":[{"code":"4507008","type":"CDM"},{"code":"250","type":"RC"},{"code":"81033000250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":160,"type":"ME"}},{"description":"Acetaminophen 325 Mg Tab [Gmh]","code_information":[{"code":"4500020","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904677361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":325,"type":"ME"}},{"description":"Acetaminophen 500 Mg Tab [Gmh]","code_information":[{"code":"4500022","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904673061","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":500,"type":"ME"}},{"description":"Acetylcysteine 600 Mg Cap","code_information":[{"code":"4507117","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295014038","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":600,"type":"ME"}},{"description":"Ascorbic Acid 500 Mg Tab [Gmh]","code_information":[{"code":"4503056","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904052361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":500,"type":"ME"}},{"description":"Aspirin 325 Mg Oral Ec Tab [Gmh]","code_information":[{"code":"4500258","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536123201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":325,"type":"ME"}},{"description":"Aspirin 81 Mg Chew Tab [Gmh]","code_information":[{"code":"4500251","type":"CDM"},{"code":"250","type":"RC"},{"code":"66553000201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":81,"type":"ME"}},{"description":"Aspirin 81 Mg Oral Ec Tab [Gmh]","code_information":[{"code":"4500250","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333003120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":81,"type":"ME"}},{"description":"Benzocaine-menthol Topical 15 Mg-3.6 Mg Loz [Gmh]","code_information":[{"code":"4504036","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904625549","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":15,"type":"ME"}},{"description":"Calcium Citrate 250 Mg Elemental Calcium Tab [Gmh]","code_information":[{"code":"4507179","type":"CDM"},{"code":"250","type":"RC"},{"code":"43292055606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":250,"type":"ME"}},{"description":"Cholecalciferol 1250 Mcg (50,000 Intunit(s) Cap [Gmh]","code_information":[{"code":"4507053","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834002001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":125,"type":"ME"}},{"description":"Dextromethorphan-guaifenesin 20 Mg-200 Mg/10 Ml Liq Ud [Gmh]","code_information":[{"code":"4507213","type":"CDM"},{"code":"250","type":"RC"},{"code":"81033010351","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":20,"type":"ME"}},{"description":"Diphenhydramine 25 Mg Cap [Gmh]","code_information":[{"code":"4500896","type":"CDM"},{"code":"250","type":"RC"},{"code":"30103072254","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":25,"type":"ME"}},{"description":"Docusate Sodium 100 Mg Cap [Gmh]","code_information":[{"code":"4500926","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904718361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":100,"type":"ME"}},{"description":"Glucose 40% Gel [Gmh]","code_information":[{"code":"4507054","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574006915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":40,"type":"EA"}},{"description":"Hydrogen Peroxide Topical 3% 473 Mlsol [Gmh]","code_information":[{"code":"4505030","type":"CDM"},{"code":"250","type":"RC"},{"code":"00869087143","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":473,"type":"ML"}},{"description":"Hydrogen Peroxide Usp 3% 473 Ml  [Gmh]","code_information":[{"code":"4500175","type":"CDM"},{"code":"250","type":"RC"},{"code":"43128000116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":473,"type":"ML"}},{"description":"Ibuprofen 100 Mg/5 Ml Oral Susp [Gmh]","code_information":[{"code":"4501331","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094060062","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":100,"type":"ME"}},{"description":"Ibuprofen 200. Mg Tab [Gmh]","code_information":[{"code":"4501344","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904791461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":200,"type":"ME"}},{"description":"Inhaler Spacer [Gmh]","code_information":[{"code":"CP17805909631540249","type":"CDM"},{"code":"250","type":"RC"},{"code":"47365017201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":"EA"}},{"description":"Juven 27.5 Gm Pkt [Gmh]","code_information":[{"code":"4507099","type":"CDM"},{"code":"250","type":"RC"},{"code":"59781066678","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":275,"type":"GR"}},{"description":"Melatonin 5 Mg Tab Ud [Gmh]","code_information":[{"code":"4506086","type":"CDM"},{"code":"250","type":"RC"},{"code":"20555003900","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":5,"type":"ME"}},{"description":"Nitratest (Phenaphthazine) Paper Ph 4.5-7.5 [Gmh]","code_information":[{"code":"4503380","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003052620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":45,"type":"EA"}},{"description":"Ocular Lubricant 0.5% Sol 0.4ml  [Gmh]","code_information":[{"code":"4502408","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023040350","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":4,"type":"ML"}},{"description":"Petrolatum Topical 100% Ointment","code_information":[{"code":"4506004","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329006801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":100,"type":"EA"}},{"description":"Tums Extra Strength 750 Mg [Gmh]","code_information":[{"code":"4502896","type":"CDM"},{"code":"250","type":"RC"},{"code":"00766738810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","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":750,"type":"ME"}},{"description":"Zofran (Ondansetron) Im Charge 4 Mg/2 Ml","code_information":[{"code":"1110136006","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Injection, Dexamethasone Sodium Phosphate, Per 1 Mg","code_information":[{"code":"3333200","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Methylprednisolone Injection 80 Mg-charge","code_information":[{"code":"3332358","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Injection, Medroxyprogesterone Acetate, 1 Mg","code_information":[{"code":"3332259","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Nebraska Total Care","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"United Healthcare ","plan_name":"Veterans Affair Community Care","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"UN"}}],"last_updated_on":"2025-06-11","location_name":["Gothenburg Health"],"hospital_address":["910 20th Street, Gothenburg, NE 69138"],"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":"Andrew Knust"},"type_2_npi":["1922051531"],"license_information":{"license_number":"220002","state":"NE"},"version":"3.0.0"}